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Harris MG, Kazdin AE, Munthali RJ, Vigo DV, Stein DJ, Viana MC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade LH, Bunting B, Chardoul S, Gureje O, Hu C, Hwang I, Karam EG, Navarro-Mateu F, Nishi D, Orozco R, Sampson NA, Scott KM, Vladescu C, Wojtyniak B, Xavier M, Zarkov Z, Kessler RC. Factors associated with satisfaction and perceived helpfulness of mental healthcare: a World Mental Health Surveys report. Int J Ment Health Syst 2024; 18:11. [PMID: 38429785 PMCID: PMC10908125 DOI: 10.1186/s13033-024-00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Mental health service providers are increasingly interested in patient perspectives. We examined rates and predictors of patient-reported satisfaction and perceived helpfulness in a cross-national general population survey of adults with 12-month DSM-IV disorders who saw a provider for help with their mental health. METHODS Data were obtained from epidemiological surveys in the World Mental Health Survey Initiative. Respondents were asked about satisfaction with treatments received from up to 11 different types of providers (very satisfied, satisfied, neither satisfied nor dissatisfied, somewhat dissatisfied, very dissatisfied) and helpfulness of the provider (a lot, some, a little, not at all). We modelled predictors of satisfaction and helpfulness using a dataset of patient-provider observations (n = 5,248). RESULTS Most treatment was provided by general medical providers (37.4%), psychiatrists (18.4%) and psychologists (12.7%). Most patients were satisfied or very satisfied (65.9-87.5%, across provider) and helped a lot or some (64.4-90.3%). Spiritual advisors and healers were most often rated satisfactory and helpful. Social workers in human services settings were rated lowest on both dimensions. Patients also reported comparatively low satisfaction with general medical doctors and psychiatrists/psychologists and found general medical doctors less helpful than other providers. Men and students reported lower levels of satisfaction than women and nonstudents. Respondents with high education reported higher satisfaction and helpfulness than those with lower education. Type of mental disorder was unrelated to satisfaction but in some cases (depression, bipolar spectrum disorder, social phobia) was associated with low perceived helpfulness. Insurance was unrelated to either satisfaction or perceived helpfulness but in some cases was associated with elevated perceived helpfulness for a given level of satisfaction. CONCLUSIONS Satisfaction with and perceived helpfulness of treatment varied as a function of type of provider, service setting, mental status, and socio-demographic variables. Invariably, caution is needed in combining data from multiple countries where there are cultural and service delivery variations. Even so, our findings underscore the utility of patient perspectives in treatment evaluation and may also be relevant in efforts to match patients to treatments.
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Affiliation(s)
- Meredith G Harris
- School of Public Health, The University of Queensland, c/o QCMHR, Locked Bag 500, Archerfield, QLD, 4108, Australia.
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wolston Park Rd, Wacol, QLD, 4076, Australia.
| | - Alan E Kazdin
- Department of Psychology, Yale University, 2 Hillhouse Avenue- 208205, New Haven, CT, 06520, USA
| | - Richard J Munthali
- Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada
| | - Daniel V Vigo
- Department of Psychiatry, University of British Columbia, UBC Hospital - Detwiller Pavilion, Room 2813, 2255 Wesbrook Mall, UBC Vancouver Campus, Vancouver, BC, V6T 2A1, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA
| | - Dan J Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Rondebosch, Cape Town, ZA, 7925, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Espirito Santo - ES, Rua Dr. Euríco de Águiar, 888/705, Vitoria, Espirito Santo - ES, 2905-600, Brazil
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, 2921 Stockton Blvd., Suite 1408, Sacramento, CA, 95817, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, P.O.Box 88, Al-Diwaniyah, Al-Qadisiyah, Iraq
| | - Jordi Alonso
- IMIM-Hospital del Mar Medical Research Institute, PRBB Building, Doctor Aiguader, 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, Madrid, 28029, Spain
- Pompeu Fabra University (UPF), Plaça de la Mercè, 10-12, Barcelona, 08002, Spain
| | - Laura Helena Andrade
- University of São Paulo Medical School, Núcleo de Epidemiologia Psiquiátrica - LIM 23, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, CEP 05403-010, Brazil
| | - Brendan Bunting
- School of Psychology, Ulster University, College Avenue, Londonderry, BT48 7JL, UK
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, 330 Packard, Room G358, Ann Arbor, MI, 48104, USA
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, University College Hospital, Ibadan, PMB, 5116, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, 518020, China
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Elie G Karam
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Achrafieh, St. George Hospital Street, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Ashrafieh, 166378, Lebanon
- Faculty of Medicine, Balamand University, Rond Point Saloumeh, Sin el Fil, Beirut, Lebanon
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigacion y Formación en Salud Mental, Servicio Murciano de Salud, Murcia Health Service, C/ Lorca, nº 58. -El Palmar, Murcia, 30120, Spain
- Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca, El Palmar, Murcia, 30120, Spain
- Centro de Investigación Biomédica en Red en Epidemíologia y Salud Pública, El Palmar, Murcia, 30120, Spain
| | - Daisuke Nishi
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Ricardo Orozco
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Calz. Mexico-Xochimilco 101, San Lorenzo Huipulco, Ciudad de México, 14370, Mexico
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, P.O. Box 56, Dunedin, 9054, New Zealand
| | - Cristian Vladescu
- National Institute for Health Services Management, 31 Vaselor Str, Bucharest, 21253, Romania
- University Titu Maiorescu, Dâmbovnicului no. 22, Bucharest, Romania
| | - Bogdan Wojtyniak
- National Institute of Public Health, National Research Institute, 24 Chocimska St, Warsaw, 00-791, Poland
| | - Miguel Xavier
- Faculdade Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, Lisbon, 1169-056, Portugal
| | - Zahari Zarkov
- Department of Mental Health, National Center of Public Health and Analyses, 15, Acad. Ivan Geshov Blvd, Sofia, 1431, Bulgaria
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, USA
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2
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Kazdin AE, Harris MG, Hwang I, Sampson NA, Stein DJ, Viana MC, Vigo DV, Wu CS, Aguilar-Gaxiola S, Alonso J, Benjet C, Bruffaerts R, Caldas-Almeida JM, Cardoso G, Caselani E, Chardoul S, Cía A, de Jonge P, Gureje O, Haro JM, Karam EG, Kovess-Masfety V, Navarro-Mateu F, Piazza M, Posada-Villa J, Scott KM, Stagnaro JC, Have MT, Torres Y, Vladescu C, Kessler RC. Patterns, predictors, and patient-reported reasons for antidepressant discontinuation in the WHO World Mental Health Surveys. Psychol Med 2024; 54:67-78. [PMID: 37706298 PMCID: PMC10872517 DOI: 10.1017/s0033291723002507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Despite their documented efficacy, substantial proportions of patients discontinue antidepressant medication (ADM) without a doctor's recommendation. The current report integrates data on patient-reported reasons into an investigation of patterns and predictors of ADM discontinuation. METHODS Face-to-face interviews with community samples from 13 countries (n = 30 697) in the World Mental Health (WMH) Surveys included n = 1890 respondents who used ADMs within the past 12 months. RESULTS 10.9% of 12-month ADM users reported discontinuation-based on recommendation of the prescriber while 15.7% discontinued in the absence of prescriber recommendation. The main patient-reported reason for discontinuation was feeling better (46.6%), which was reported by a higher proportion of patients who discontinued within the first 2 weeks of treatment than later. Perceived ineffectiveness (18.5%), predisposing factors (e.g. fear of dependence) (20.0%), and enabling factors (e.g. inability to afford treatment cost) (5.0%) were much less commonly reported reasons. Discontinuation in the absence of prescriber recommendation was associated with low country income level, being employed, and having above average personal income. Age, prior history of psychotropic medication use, and being prescribed treatment from a psychiatrist rather than from a general medical practitioner, in comparison, were associated with a lower probability of this type of discontinuation. However, these predictors varied substantially depending on patient-reported reasons for discontinuation. CONCLUSION Dropping out early is not necessarily negative with almost half of individuals noting they felt better. The study underscores the diverse reasons given for dropping out and the need to evaluate how and whether dropping out influences short- or long-term functioning.
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Affiliation(s)
- Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Meredith G. Harris
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD 4072, Australia
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Dan J. Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town, South Africa
- Groote Schuur Hospital, Cape Town, South Africa
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Daniel V. Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Chi-shin Wu
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan Town, Taiwan
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Department of Medicine and Life Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Corina Benjet
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - José Miguel Caldas-Almeida
- Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre (CHRC), NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Elisa Caselani
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Stephanie Chardoul
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Alfredo Cía
- Anxiety Disorders Research Center, Buenos Aires, Argentina
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, The Netherlands
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Centre for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
- Departament de Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | | | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Gerencia Salud Mental, Servicio Murciano de Salud, Murcia, Spain
- Murcia Biomedical Research Institute (IMIB-Arrixaca), Murcia, Spain
- CIBER Epidemiology and Public Health-Murcia (CIBERESP-Murcia), Murcia, Spain
| | - Marina Piazza
- Instituto Nacional de Salud, Lima, Peru
- Universidad Cayetano Heredia, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Cristian Vladescu
- National Institute for Health Services Management, Bucharest, Romania
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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3
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Axinn WG, Bruffaerts R, Kessler TL, Frounfelker R, Aguilar-Gaxiola S, Alonso J, Bunting B, Caldas-de-Almeida JM, Cardoso G, Chardoul S, Chiu WT, Cía A, Gureje O, Karam EG, Kovess-Masfety V, Petukhova MV, Piazza M, Posada-Villa J, Sampson NA, Scott KM, Stagnaro JC, Stein DJ, Torres Y, Williams DR, Kessler RC. Findings From the World Mental Health Surveys of Civil Violence Exposure and Its Association With Subsequent Onset and Persistence of Mental Disorders. JAMA Netw Open 2023; 6:e2318919. [PMID: 37338903 PMCID: PMC10282884 DOI: 10.1001/jamanetworkopen.2023.18919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/23/2023] [Indexed: 06/21/2023] Open
Abstract
Importance Understanding the association of civil violence with mental disorders is important for developing effective postconflict recovery policies. Objective To estimate the association between exposure to civil violence and the subsequent onset and persistence of common mental disorders (in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV]) in representative surveys of civilians from countries that have experienced civil violence since World War II. Design, Setting, and Participants This study used data from cross-sectional World Health Organization World Mental Health (WMH) surveys administered to households between February 5, 2001, and January 5, 2022, in 7 countries that experienced periods of civil violence after World War II (Argentina, Colombia, Lebanon, Nigeria, Northern Ireland, Peru, and South Africa). Data from respondents in other WMH surveys who immigrated from countries with civil violence in Africa and Latin America were also included. Representative samples comprised adults (aged ≥18 years) from eligible countries. Data analysis was performed from February 10 to 13, 2023. Exposures Exposure was defined as a self-report of having been a civilian in a war zone or region of terror. Related stressors (being displaced, witnessing atrocities, or being a combatant) were also assessed. Exposures occurred a median of 21 (IQR, 12-30) years before the interview. Main Outcomes and Measures The main outcome was the retrospectively reported lifetime prevalence and 12-month persistence (estimated by calculating 12-month prevalence among lifetime cases) of DSM-IV anxiety, mood, and externalizing (alcohol use, illicit drug use, or intermittent explosive) disorders. Results This study included 18 212 respondents from 7 countries. Of these individuals, 2096 reported that they were exposed to civil violence (56.5% were men; median age, 40 [IQR, 30-52] years) and 16 116 were not exposed (45.2% were men; median age, 35 [IQR, 26-48] years). Respondents who reported being exposed to civil violence had a significantly elevated onset risk of anxiety (risk ratio [RR], 1.8 [95% CI, 1.5-2.1]), mood (RR, 1.5 [95% CI, 1.3-1.7]), and externalizing (RR, 1.6 [95% CI, 1.3-1.9]) disorders. Combatants additionally had a significantly elevated onset risk of anxiety disorders (RR, 2.0 [95% CI, 1.3-3.1]) and refugees had an increased onset risk of mood (RR, 1.5 [95% CI, 1.1-2.0]) and externalizing (RR, 1.6 [95% CI, 1.0-2.4]) disorders. Elevated disorder onset risks persisted for more than 2 decades if conflicts persisted but not after either termination of hostilities or emigration. Persistence (ie, 12-month prevalence among respondents with lifetime prevalence of the disorder), in comparison, was generally not associated with exposure. Conclusions In this survey study of exposure to civil violence, exposure was associated with an elevated risk of mental disorders among civilians for many years after initial exposure. These findings suggest that policy makers should recognize these associations when projecting future mental disorder treatment needs in countries experiencing civil violence and among affected migrants.
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Affiliation(s)
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum–Katholieke Universiteit, Campus Gasthuisberg, Leuven, Belgium
| | - Timothy L. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Rochelle Frounfelker
- Department of Community and Population Health, Lehigh University, Bethlehem, Pennsylvania
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, University of California, Davis Health System, Sacramento
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain
- Biomedical Research Networking Center in Epidemiology and Public Health, Barcelona, Spain
- Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Comprehensive Health Research Centre, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Alfredo Cía
- Anxiety Disorders Research Center, Buenos Aires, Argentina
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Beirut, Lebanon
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care, Beirut, Lebanon
| | | | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Marina Piazza
- Instituto Nacional de Salud, Universidad Cayetano Heredia, Lima, Peru
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Dan J. Stein
- South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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4
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Bharat C, Glantz MD, Aguilar-Gaxiola S, Alonso J, Bruffaerts R, Bunting B, Caldas-de-Almeida JM, Cardoso G, Chardoul S, de Jonge P, Gureje O, Haro JM, Harris MG, Karam EG, Kawakami N, Kiejna A, Kovess-Masfety V, Lee S, McGrath JJ, Moskalewicz J, Navarro-Mateu F, Rapsey C, Sampson NA, Scott KM, Tachimori H, Ten Have M, Vilagut G, Wojtyniak B, Xavier M, Kessler RC, Degenhardt L. Development and evaluation of a risk algorithm predicting alcohol dependence after early onset of regular alcohol use. Addiction 2023; 118:954-966. [PMID: 36609992 PMCID: PMC10073308 DOI: 10.1111/add.16122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 12/10/2022] [Indexed: 01/09/2023]
Abstract
AIMS Likelihood of alcohol dependence (AD) is increased among people who transition to greater levels of alcohol involvement at a younger age. Indicated interventions delivered early may be effective in reducing risk, but could be costly. One way to increase cost-effectiveness would be to develop a prediction model that targeted interventions to the subset of youth with early alcohol use who are at highest risk of subsequent AD. DESIGN A prediction model was developed for DSM-IV AD onset by age 25 years using an ensemble machine-learning algorithm known as 'Super Learner'. Shapley additive explanations (SHAP) assessed variable importance. SETTING AND PARTICIPANTS Respondents reporting early onset of regular alcohol use (i.e. by 17 years of age) who were aged 25 years or older at interview from 14 representative community surveys conducted in 13 countries as part of WHO's World Mental Health Surveys. MEASUREMENTS The primary outcome to be predicted was onset of life-time DSM-IV AD by age 25 as measured using the Composite International Diagnostic Interview, a fully structured diagnostic interview. FINDINGS AD prevalence by age 25 was 5.1% among the 10 687 individuals who reported drinking alcohol regularly by age 17. The prediction model achieved an external area under the curve [0.78; 95% confidence interval (CI) = 0.74-0.81] higher than any individual candidate risk model (0.73-0.77) and an area under the precision-recall curve of 0.22. Overall calibration was good [integrated calibration index (ICI) = 1.05%]; however, miscalibration was observed at the extreme ends of the distribution of predicted probabilities. Interventions provided to the 20% of people with highest risk would identify 49% of AD cases and require treating four people without AD to reach one with AD. Important predictors of increased risk included younger onset of alcohol use, males, higher cohort alcohol use and more mental disorders. CONCLUSIONS A risk algorithm can be created using data collected at the onset of regular alcohol use to target youth at highest risk of alcohol dependence by early adulthood. Important considerations remain for advancing the development and practical implementation of such models.
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Affiliation(s)
- Chrianna Bharat
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales Australia, Sydney, NSW, Australia
| | - Meyer D Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institute of Health (NIH), Bethesda, MA, USA
| | | | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Life and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | | | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Stephanie Chardoul
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Research, Teaching and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Centre for Biomedical Research on Mental Health (CIBERSAM), Madrid, Spain
| | - Meredith G Harris
- School of Public Health, The University of Queensland, Herston, QLD, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Institute for Development, Research, Advocacy and Applied Care (IDRAAC), St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Andrzej Kiejna
- Institute of Psychology, University of Lower Silesia, Wroclaw, Poland
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia.,Queensland Brain Institute, The University of Queensland, National Centre for Register-based Research, Aarhus University, Aarhus V, Denmark
| | | | - Fernando Navarro-Mateu
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Basic Psychology and Methodology, University of Murcia, Murcia Biomedical Research Institute (IMIB-Arrixaca), Unidad de Docencia, Investigación y Formación en Salud Mental, Servicio Murciano de Salud, Murcia, Spain
| | - Charlene Rapsey
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Hisateru Tachimori
- Department of Clinical Data Science, Clinical Research and Education Promotion Division, National Center of Neurology and Psychiatry, Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Gemma Vilagut
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Bogdan Wojtyniak
- Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Research Institute, Warsaw, Poland
| | - Miguel Xavier
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales Australia, Sydney, NSW, Australia
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5
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Gmelin JOH, De Vries YA, Baams L, Aguilar-Gaxiola S, Alonso J, Borges G, Bunting B, Cardoso G, Florescu S, Gureje O, Karam EG, Kawakami N, Lee S, Mneimneh Z, Navarro-Mateu F, Posada-Villa J, Rapsey C, Slade T, Stagnaro JC, Torres Y, Kessler RC, de Jonge P. Increased risks for mental disorders among LGB individuals: cross-national evidence from the World Mental Health Surveys. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2319-2332. [PMID: 35851652 PMCID: PMC9636102 DOI: 10.1007/s00127-022-02320-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Lesbian, gay, and bisexual (LGB) individuals, and LB women specifically, have an increased risk for psychiatric morbidity, theorized to result from stigma-based discrimination. To date, no study has investigated the mental health disparities between LGB and heterosexual AQ1individuals in a large cross-national population-based comparison. The current study addresses this gap by examining differences between LGB and heterosexual participants in 13 cross-national surveys, and by exploring whether these disparities were associated with country-level LGBT acceptance. Since lower social support has been suggested as a mediator of sexual orientation-based differences in psychiatric morbidity, our secondary aim was to examine whether mental health disparities were partially explained by general social support from family and friends. METHODS Twelve-month prevalence of DSM-IV anxiety, mood, eating, disruptive behavior, and substance disorders was assessed with the WHO Composite International Diagnostic Interview in a general population sample across 13 countries as part of the World Mental Health Surveys. Participants were 46,889 adults (19,887 males; 807 LGB-identified). RESULTS Male and female LGB participants were more likely to report any 12-month disorder (OR 2.2, p < 0.001 and OR 2.7, p < 0.001, respectively) and most individual disorders than heterosexual participants. We found no evidence for an association between country-level LGBT acceptance and rates of psychiatric morbidity between LGB and heterosexualAQ2 participants. However, among LB women, the increased risk for mental disorders was partially explained by lower general openness with family, although most of the increased risk remained unexplained. CONCLUSION These results provide cross-national evidence for an association between sexual minority status and psychiatric morbidity, and highlight that for women, but not men, this association was partially mediated by perceived openness with family. Future research into individual-level and cross-national sexual minority stressors is needed.
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Affiliation(s)
- Jan-Ole H. Gmelin
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Ymkje Anna De Vries
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Laura Baams
- Department of Pedagogy and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | | | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Guilherme Borges
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | - Graca Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Fernando Navarro-Mateu
- IDRAAC, Beirut, Lebanon
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Charlene Rapsey
- Department of Psychological Medicine, University of Otago, Dunedin, Otago New Zealand
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
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6
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Boulware LE, Vitale A, Ruiz R, Corbie G, Aguilar-Gaxiola S, Wilkins CH, Egede LE. Diversity, equity and inclusion actions from the NCATS Clinical and Translational Science awarded programs. Nat Med 2022; 28:1730-1731. [PMID: 35764682 PMCID: PMC9244304 DOI: 10.1038/s41591-022-01863-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Alfred Vitale
- University of Rochester Medical Center, Rochester, NY, USA
| | - Raquel Ruiz
- Duke University School of Medicine, Durham, NC, USA
| | - Giselle Corbie
- University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC, USA
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7
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Aguilar-Gaxiola S, Ahmed SM, Anise A, Azzahir A, Baker KE, Cupito A, Eder M, Everette TD, Erwin K, Felzien M, Freeman E, Gibbs D, Greene-Moton E, Hernández-Cancio S, Hwang A, Jones F, Jones G, Jones M, Khodyakov D, Michener JL, Milstein B, Oto-Kent DS, Orban M, Pusch B, Shah M, Shaw M, Tarrant J, Wallerstein N, Westfall JM, Williams A, Zaldivar R. Assessing Meaningful Community Engagement: A Conceptual Model to Advance Health Equity through Transformed Systems for Health: Organizing Committee for Assessing Meaningful Community Engagement in Health & Health Care Programs & Policies. NAM Perspect 2022; 2022:202202c. [PMID: 35891775 PMCID: PMC9303007 DOI: 10.31478/202202c] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Elmer Freeman
- Center for Community Health Education Research and Service
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8
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Boulware LE, Corbie G, Aguilar-Gaxiola S, Wilkins CH, Ruiz R, Vitale A, Egede LE. Combating Structural Inequities - Diversity, Equity, and Inclusion in Clinical and Translational Research. N Engl J Med 2022; 386:201-203. [PMID: 35029847 DOI: 10.1056/nejmp2112233] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- L Ebony Boulware
- From Duke University School of Medicine, Durham (L.E.B.), and the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (G.C.) - both in North Carolina; the University of California, Davis, School of Medicine, Sacramento (S.A.-G.); Vanderbilt University School of Medicine, Nashville (C.H.W.); the University of Rochester Medical Center, Rochester, NY (R.R., A.V.); and the Medical College of Wisconsin, Milwaukee (L.E.E.)
| | - Giselle Corbie
- From Duke University School of Medicine, Durham (L.E.B.), and the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (G.C.) - both in North Carolina; the University of California, Davis, School of Medicine, Sacramento (S.A.-G.); Vanderbilt University School of Medicine, Nashville (C.H.W.); the University of Rochester Medical Center, Rochester, NY (R.R., A.V.); and the Medical College of Wisconsin, Milwaukee (L.E.E.)
| | - Sergio Aguilar-Gaxiola
- From Duke University School of Medicine, Durham (L.E.B.), and the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (G.C.) - both in North Carolina; the University of California, Davis, School of Medicine, Sacramento (S.A.-G.); Vanderbilt University School of Medicine, Nashville (C.H.W.); the University of Rochester Medical Center, Rochester, NY (R.R., A.V.); and the Medical College of Wisconsin, Milwaukee (L.E.E.)
| | - Consuelo H Wilkins
- From Duke University School of Medicine, Durham (L.E.B.), and the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (G.C.) - both in North Carolina; the University of California, Davis, School of Medicine, Sacramento (S.A.-G.); Vanderbilt University School of Medicine, Nashville (C.H.W.); the University of Rochester Medical Center, Rochester, NY (R.R., A.V.); and the Medical College of Wisconsin, Milwaukee (L.E.E.)
| | - Raquel Ruiz
- From Duke University School of Medicine, Durham (L.E.B.), and the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (G.C.) - both in North Carolina; the University of California, Davis, School of Medicine, Sacramento (S.A.-G.); Vanderbilt University School of Medicine, Nashville (C.H.W.); the University of Rochester Medical Center, Rochester, NY (R.R., A.V.); and the Medical College of Wisconsin, Milwaukee (L.E.E.)
| | - Alfred Vitale
- From Duke University School of Medicine, Durham (L.E.B.), and the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (G.C.) - both in North Carolina; the University of California, Davis, School of Medicine, Sacramento (S.A.-G.); Vanderbilt University School of Medicine, Nashville (C.H.W.); the University of Rochester Medical Center, Rochester, NY (R.R., A.V.); and the Medical College of Wisconsin, Milwaukee (L.E.E.)
| | - Leonard E Egede
- From Duke University School of Medicine, Durham (L.E.B.), and the University of North Carolina at Chapel Hill School of Medicine, Chapel Hill (G.C.) - both in North Carolina; the University of California, Davis, School of Medicine, Sacramento (S.A.-G.); Vanderbilt University School of Medicine, Nashville (C.H.W.); the University of Rochester Medical Center, Rochester, NY (R.R., A.V.); and the Medical College of Wisconsin, Milwaukee (L.E.E.)
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9
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Boulware LE, Vitale A, Ruiz R, Corbie G, Aguilar-Gaxiola S, Wilkins CH, Egede LE. Author Correction: Diversity, equity and inclusion actions from the NCATS Clinical and Translational Science awarded programs. Nat Med 2022; 28:2217. [PMID: 35945285 PMCID: PMC9744123 DOI: 10.1038/s41591-022-01995-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- L. Ebony Boulware
- grid.26009.3d0000 0004 1936 7961Duke University School of Medicine, Durham, NC USA
| | - Alfred Vitale
- grid.412750.50000 0004 1936 9166University of Rochester Medical Center, Rochester, NY USA
| | - Raquel Ruiz
- grid.26009.3d0000 0004 1936 7961Duke University School of Medicine, Durham, NC USA
| | - Giselle Corbie
- grid.10698.360000000122483208University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Sergio Aguilar-Gaxiola
- grid.27860.3b0000 0004 1936 9684University California Davis School of Medicine, Sacramento, CA USA
| | - Consuelo H. Wilkins
- grid.412807.80000 0004 1936 9916Vanderbilt University Medical Center, Nashville, TN USA
| | - Leonard E. Egede
- grid.30760.320000 0001 2111 8460Medical College of Wisconsin, Milwaukee, WI USA
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10
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Goodsmith N, Moore EM, Siddiq H, Barceló SE, Ulloa-Flores E, Loera G, Jones F, Aguilar-Gaxiola S, Wells K, Arevian A. Community-Partnered Development of a Digital Mental Health Resource Website to Support Diverse Communities During the COVID-19 Pandemic. J Health Care Poor Underserved 2022; 33:506-516. [PMID: 35153238 PMCID: PMC10036170 DOI: 10.1353/hpu.2022.0039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A state-academic-community partnership formed in response to the mental health needs fueled by the COVID-19 pandemic and the disproportionate effects on marginalized communities. Taking a community-partnered approach and using a health equity lens, the partnership developed a website to guide users through digital mental health resources, prioritizing accessibility, engagement, and community needs.
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11
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Casillas A, Rosas LG, Carson SL, Orechwa A, North G, AuYoung M, Kim G, Guereca JA, Ramers CB, Burke NJ, Corchado CG, Aguilar-Gaxiola S, Cheney A, Rabin BA, Stadnick NA, Oswald W, Cabrera A, Sorkin DH, Zaldivar F, Wong W, Yerraguntala AS, Vassar SD, Wright AL, Washington DL, Norris KC, Brown AF. STOP COVID-19 CA: Community engagement to address the disparate impacts of the COVID-19 pandemic in California. Front Health Serv 2022; 2:935297. [PMID: 36925779 PMCID: PMC10012632 DOI: 10.3389/frhs.2022.935297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/10/2022] [Indexed: 12/03/2022]
Abstract
Objective To describe the early activities and lessons of the Share, Trust, Organize, Partner COVID-19 California Alliance (STOP COVID-19 CA), the California awardee of the NIH-funded multi-state Community Engagement Alliance (CEAL) against COVID-19. The Alliance was established to ensure equity in Coronavirus-19 disease (COVID-19) research, clinical practice, and public health for communities most impacted by the COVID-19 pandemic. Study setting The STOP COVID-19 CA Alliance network of 11 universities and affiliated partner community-based organizations (CBOs) across California. Study design Mixed methods evaluation consisting of an analysis of activity (August 2020 to December 2021) detailed in reports submitted by community-academic teams and a survey (August 2021) of academic investigators and affiliated community-based organization (CBO) partners. Data collection We summarized activities from the 11 community-academic teams' progress reports and described results from an online survey of academic investigators and CBO partners in the California Alliance. Principal findings A review of progress reports (n = 256) showed that teams fielded surveys to 11,000 Californians, conducted 133 focus groups, partnered with 29 vaccine/therapeutics clinical trials, and led more than 300 town halls and vaccine events that reached Californians from communities disproportionately impacted by COVID-19. Survey responses from academic investigators and CBO partners emphasized the importance of learning from the successes and challenges of the California Alliance teams' COVID-19 initiatives. Both academic and CBO respondents highlighted the need for streamlined federal and institutional administrative policies, and fiscal practices to promote more effective and timely operations of teams in their efforts to address the numerous underlying health and social disparities that predispose their communities to higher rates of, and poor outcomes from, COVID-19. Conclusions STOP COVID-19 CA represents a new and potentially sustainable statewide community engagement model for addressing health disparities in multiethnic/multicultural and geographically dispersed communities.
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Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Lisa G Rosas
- Department of Epidemiology and Population Health, Stanford School of Medicine, Stanford, CA, United States.,Division of Primary Care and Population Health, Department of Medicine, Stanford School of Medicine, Stanford, CA, United States
| | - Savanna L Carson
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Allison Orechwa
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Gemma North
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | | | - Gloria Kim
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Jesus A Guereca
- Laura Rodriguez Research Institute Family Health Centers of San Diego, San Diego, CA, United States
| | - Christian B Ramers
- Division of Infectious Diseases, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Nancy J Burke
- Public Health Department, University of California, Merced, Merced, CA, United States
| | | | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities and Community Engagement Program of the Clinical and Translational Science Center, Department of Internal Medicine, University of California, Davis, Sacramento, CA, United States
| | - Ann Cheney
- Department of Social Medicine Population and Public Health, School of Medicine, University of California, Riverside, Riverside, CA, United States
| | - Borsika A Rabin
- UC San Diego Altman Clinical Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
| | - Nicole A Stadnick
- UC San Diego Altman Clinical Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, United States.,Department of Psychiatry, School of Medicine, University of California San Diego, La Jolla, CA, United States.,Child and Adolescent Services Research Center, San Diego, CA, United States
| | - William Oswald
- The Global Action Research Center, San Diego, CA, United States
| | - Abby Cabrera
- Center for Excellence in Primary Care, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Dara H Sorkin
- Department of Medicine, Institute for Clinical and Translational Science, University of California, Irvine, Irvine, CA, United States
| | - Frank Zaldivar
- Department of Pediatrics, Susan and Henry Samueli College of Health Sciences, University of California, Irvine, Irvine, CA, United States
| | - Wennie Wong
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Anusha S Yerraguntala
- Southern California Clinical and Translational Science Institute, University of Southern California, Los Angeles, CA, United States
| | - Stefanie D Vassar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Aziza Lucas Wright
- Department of Preventive and Social Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, United States.,South Central Prevention Coalition, Los Angeles, CA, United States
| | - Donna L Washington
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States.,Olive View Medical Center, Los Angeles County Department of Health Services, Sylmar, CA, United States
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Fernández D, Vigo D, Sampson NA, Hwang I, Aguilar-Gaxiola S, Al-Hamzawi AO, Alonso J, Andrade LH, Bromet EJ, de Girolamo G, de Jonge P, Florescu S, Gureje O, Hinkov H, Hu C, Karam EG, Karam G, Kawakami N, Kiejna A, Kovess-Masfety V, Medina-Mora ME, Navarro-Mateu F, Ojagbemi A, O’Neill S, Piazza M, Posada-Villa J, Rapsey C, Williams DR, Xavier M, Ziv Y, Kessler RC, Haro JM. Patterns of care and dropout rates from outpatient mental healthcare in low-, middle- and high-income countries from the World Health Organization's World Mental Health Survey Initiative. Psychol Med 2021; 51:2104-2116. [PMID: 32343221 PMCID: PMC8265313 DOI: 10.1017/s0033291720000884] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries. METHODS Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan-Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function. RESULTS Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care. CONCLUSIONS Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
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Affiliation(s)
- Daniel Fernández
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
- Serra Húnter fellow. Department of Statistics and Operations Research, Polytechnic University of Catalonia, Barcelona, Spain
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali O. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | | | - Peter de Jonge
- Department of Developmental Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Hristo Hinkov
- National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Andrzej Kiejna
- Wroclaw Medical University; University of Lower Silesia, Wroclaw, Poland
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Siobhan O’Neill
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | | | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Charlene Rapsey
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Miguel Xavier
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Yuval Ziv
- Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
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13
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Stein DJ, Kazdin AE, Ruscio AM, Chiu WT, Sampson NA, Ziobrowski HN, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Altwaijri Y, Bruffaerts R, Bunting B, de Girolamo G, de Jonge P, Degenhardt L, Gureje O, Haro JM, Harris MG, Karam A, Karam EG, Kovess-Masfety V, Lee S, Medina-Mora ME, Moskalewicz J, Navarro-Mateu F, Nishi D, Posada-Villa J, Scott KM, Viana MC, Vigo DV, Xavier M, Zarkov Z, Kessler RC. Perceived helpfulness of treatment for generalized anxiety disorder: a World Mental Health Surveys report. BMC Psychiatry 2021; 21:392. [PMID: 34372811 PMCID: PMC8351147 DOI: 10.1186/s12888-021-03363-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment guidelines for generalized anxiety disorder (GAD) are based on a relatively small number of randomized controlled trials and do not consider patient-centered perceptions of treatment helpfulness. We investigated the prevalence and predictors of patient-reported treatment helpfulness for DSM-5 GAD and its two main treatment pathways: encounter-level treatment helpfulness and persistence in help-seeking after prior unhelpful treatment. METHODS Data came from community epidemiologic surveys in 23 countries in the WHO World Mental Health surveys. DSM-5 GAD was assessed with the fully structured WHO Composite International Diagnostic Interview Version 3.0. Respondents with a history of GAD were asked whether they ever received treatment and, if so, whether they ever considered this treatment helpful. Number of professionals seen before obtaining helpful treatment was also assessed. Parallel survival models estimated probability and predictors of a given treatment being perceived as helpful and of persisting in help-seeking after prior unhelpful treatment. RESULTS The overall prevalence rate of GAD was 4.5%, with lower prevalence in low/middle-income countries (2.8%) than high-income countries (5.3%); 34.6% of respondents with lifetime GAD reported ever obtaining treatment for their GAD, with lower proportions in low/middle-income countries (19.2%) than high-income countries (38.4%); 3) 70% of those who received treatment perceived the treatment to be helpful, with prevalence comparable in low/middle-income countries and high-income countries. Survival analysis suggested that virtually all patients would have obtained helpful treatment if they had persisted in help-seeking with up to 10 professionals. However, we estimated that only 29.7% of patients would have persisted that long. Obtaining helpful treatment at the person-level was associated with treatment type, comorbid panic/agoraphobia, and childhood adversities, but most of these predictors were important because they predicted persistence rather than encounter-level treatment helpfulness. CONCLUSIONS The majority of individuals with GAD do not receive treatment. Most of those who receive treatment regard it as helpful, but receiving helpful treatment typically requires persistence in help-seeking. Future research should focus on ensuring that helpfulness is included as part of the evaluation. Clinicians need to emphasize the importance of persistence to patients beginning treatment.
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Affiliation(s)
- Dan J. Stein
- grid.7836.a0000 0004 1937 1151Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alan E. Kazdin
- grid.47100.320000000419368710Department of Psychology, Yale University, New Haven, CT USA
| | - Ayelet Meron Ruscio
- grid.25879.310000 0004 1936 8972Department of Psychology, University of Pennsylvania, Philadelphia, PA USA
| | - Wai Tat Chiu
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Nancy A. Sampson
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Hannah N. Ziobrowski
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Sergio Aguilar-Gaxiola
- grid.416958.70000 0004 0413 7653Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Al Diwaniyah, Iraq
| | - Jordi Alonso
- grid.20522.370000 0004 1767 9005Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain ,grid.413448.e0000 0000 9314 1427CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.5612.00000 0001 2172 2676Pompeu Fabra University (UPF), Barcelona, Spain
| | - Yasmin Altwaijri
- grid.415310.20000 0001 2191 4301Epidemiology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ronny Bruffaerts
- grid.5596.f0000 0001 0668 7884Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- grid.12641.300000000105519715School of Psychology, Ulster University, Londonderry, UK
| | - Giovanni de Girolamo
- grid.419422.8IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Peter de Jonge
- grid.4830.f0000 0004 0407 1981Department of Developmental Psychology, University of Groningen, Groningen, Netherlands ,grid.4494.d0000 0000 9558 4598Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, Netherlands
| | - Louisa Degenhardt
- grid.1005.40000 0004 4902 0432National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Oye Gureje
- grid.412438.80000 0004 1764 5403Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- grid.5841.80000 0004 1937 0247Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Meredith G. Harris
- grid.1003.20000 0000 9320 7537School of Public Health, The University of Queensland, Herston, QLD 4006 Australia ,grid.417162.70000 0004 0606 3563Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD 4072 Australia
| | - Aimee Karam
- grid.429040.bInstitute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - Elie G. Karam
- grid.429040.bInstitute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon ,grid.416659.90000 0004 1773 3761Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon ,grid.33070.370000 0001 2288 0342Faculty of Medicine, Balamand University, Beirut, Lebanon
| | - Viviane Kovess-Masfety
- grid.508487.60000 0004 7885 7602Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- grid.10784.3a0000 0004 1937 0482Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Maria Elena Medina-Mora
- grid.419154.c0000 0004 1776 9908National Institute of Psychiatry-Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jacek Moskalewicz
- grid.418955.40000 0001 2237 2890Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Fernando Navarro-Mateu
- grid.419058.10000 0000 8745 438XUDIF-SM, Servicio Murciano de Salud; IMIB-Arrixaca; CIBERESP-Murcia, Región de Murcia, Murcia, Spain
| | - Daisuke Nishi
- grid.26999.3d0000 0001 2151 536XDepartment of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ,grid.419280.60000 0004 1763 8916National Center of Neurology and Psychiatry, Tokyo, Japan
| | - José Posada-Villa
- grid.441728.c0000 0004 1779 6631Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Kate M. Scott
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Dunedin, Otago New Zealand
| | - Maria Carmen Viana
- grid.412371.20000 0001 2167 4168Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Daniel V. Vigo
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada ,grid.38142.3c000000041936754XDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Miguel Xavier
- grid.10772.330000000121511713Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School-Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Zahari Zarkov
- grid.416574.5Department of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C. Kessler
- grid.38142.3c000000041936754XDepartment of Health Care Policy, Harvard Medical School, Boston, MA USA
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14
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Vigo D, Haro JM, Hwang I, Aguilar-Gaxiola S, Alonso J, Borges G, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, Florescu S, Gureje O, Karam E, Karam G, Kovess-Masfety V, Lee S, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Sampson NA, Scott K, Stagnaro JC, Have MT, Viana MC, Wu CS, Chatterji S, Cuijpers P, Thornicroft G, Kessler RC. Toward measuring effective treatment coverage: critical bottlenecks in quality- and user-adjusted coverage for major depressive disorder. Psychol Med 2020; 52:1-11. [PMID: 33077023 PMCID: PMC9341444 DOI: 10.1017/s0033291720003797] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a leading cause of morbidity and mortality. Shortfalls in treatment quantity and quality are well-established, but the specific gaps in pharmacotherapy and psychotherapy are poorly understood. This paper analyzes the gap in treatment coverage for MDD and identifies critical bottlenecks. METHODS Seventeen surveys were conducted across 15 countries by the World Health Organization-World Mental Health Surveys Initiative. Of 35 012 respondents, 3341 met DSM-IV criteria for 12-month MDD. The following components of effective treatment coverage were analyzed: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) adequate severity-specific combination of both. RESULTS MDD prevalence was 4.8% (s.e., 0.2). A total of 41.8% (s.e., 1.1) received any mental health services, 23.2% (s.e., 1.5) of which was deemed effective. This 90% gap in effective treatment is due to lack of utilization (58%) and inadequate quality or adherence (32%). Critical bottlenecks are underutilization of psychotherapy (26 percentage-points reduction in coverage), underutilization of psychopharmacology (13-point reduction), inadequate physician monitoring (13-point reduction), and inadequate drug-type (10-point reduction). High-income countries double low-income countries in any mental health service utilization, adequate pharmacotherapy, adequate psychotherapy, and adequate combination of both. Severe cases are more likely than mild-moderate cases to receive either adequate pharmacotherapy or psychotherapy, but less likely to receive an adequate combination. CONCLUSIONS Decision-makers need to increase the utilization and quality of pharmacotherapy and psychotherapy. Innovations such as telehealth for training and supervision plus non-specialist or community resources to deliver pharmacotherapy and psychotherapy could address these bottlenecks.
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Affiliation(s)
- Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Irving Hwang
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
| | - Guilherme Borges
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Jose Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Elie Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, University of Ibadan, Nigeria
| | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Chi-Shin Wu
- Department of Psychiatry, National Taiwan University Hospital & College of Medicine, Taipei, Taiwan
| | - Somnath Chatterji
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University, Amsterdam
- The Netherlands & EMGO Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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15
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Arevian AC, Jones F, Moore EM, Goodsmith N, Aguilar-Gaxiola S, Ewing T, Siddiq H, Lester P, Cheung E, Ijadi-Maghsoodi R, Gabrielian S, Sugarman OK, Bonds C, Benitez C, Innes-Gomberg D, Springgate B, Haywood C, Meyers D, Sherin JE, Wells K. Mental Health Community and Health System Issues in COVID-19: Lessons from Academic, Community, Provider and Policy Stakeholders. Ethn Dis 2020; 30:695-700. [PMID: 32989370 PMCID: PMC7518533 DOI: 10.18865/ed.30.4.695] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The coronavirus pandemic of 2019 (COVID-19) has created unprecedented changes to everyday life for millions of Americans due to job loss, school closures, stay-at-home orders and health and mortality consequences. In turn, physicians, academics, and policymakers have turned their attention to the public mental health toll of COVID-19. This commentary reporting from the field integrates perceptions of academic, community, health system, and policy leaders from state, county, and local levels in commenting on community mental health needs in the COVID-19 pandemic. Stakeholders noted the broad public health scope of mental health challenges while expressing concern about exacerbation of existing disparities in access and adverse social determinants, including for communities with high COVID-19 infection rates, such as African Americans and Latinos. They noted rapid changes toward telehealth and remote care, and the importance of understanding impacts of changes, including who may benefit or have limited access, with implications for future services delivery. Needs for expanded workforce and training in mental health were noted, as well as potential public health value of expanding digital resources tailored to local populations for enhancing resilience to stressors. The COVID-19 pandemic has led to changes in delivery of health care services across populations and systems. Concerns over the mental health impact of COVID-19 has enhanced interest in remote mental care delivery and preventive services, while being mindful of potential for enhanced disparities and needs to address social determinants of health. Ongoing quality improvement across systems can integrate lessons learned to enhance a public mental well-being.
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Affiliation(s)
- Armen C. Arevian
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Elizabeth M. Moore
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA National Clinician Scholars Program, Los Angeles, CA
| | - Nichole Goodsmith
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA National Clinician Scholars Program, Los Angeles, CA
| | - Sergio Aguilar-Gaxiola
- Department of Clinical Internal Medicine, School of Medicine, and Center for Reducing Health Disparities, UC Davis, Davis, CA
| | - Toby Ewing
- California Mental Health Services Oversight and Accountability Commission, Sacramento, CA
| | - Hafifa Siddiq
- UCLA National Clinician Scholars Program, Los Angeles, CA
- UCLA Resource Center for Minority Aging Research, Resource Centers for Minority Aging and for Health Improvement of Minority Elderly, Los Angeles, CA
| | - Patricia Lester
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
| | - Erick Cheung
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Roya Ijadi-Maghsoodi
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
| | - Sonya Gabrielian
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
| | - Olivia K. Sugarman
- Louisiana State University Health Sciences Center – New Orleans School of Medicine and School of Public Health, New Orleans, LA
| | - Curley Bonds
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Christopher Benitez
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Benjamin Springgate
- Louisiana State University Health Sciences Center – New Orleans School of Medicine and School of Public Health, New Orleans, LA
| | | | | | - Jonathan E. Sherin
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- Los Angeles County Department of Mental Health, Los Angeles, CA
- University of Southern California, Los Angeles, CA
| | - Kenneth Wells
- Resnick Neuropsychiatric Hospital and Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
- VA Greater Los Angeles Healthcare System HSR&D Center for the Study of Healthcare Innovation Implementation & Policy, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Division of Population Behavioral Health, Los Angeles, CA
- UCLA/VA Center of Excellence for Veteran Resilience and Recovery, Los Angeles, CA
- UCLA Fielding School of Public Health, Los Angeles, CA
- UCLA Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Health Services and Society, Los Angeles, CA
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16
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Harris MG, Kazdin AE, Chiu WT, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Altwaijri Y, Andrade LH, Cardoso G, Cía A, Florescu S, Gureje O, Hu C, Karam EG, Karam G, Mneimneh Z, Navarro-Mateu F, Oladeji BD, O’Neill S, Scott K, Slade T, Torres Y, Vigo D, Wojtyniak B, Zarkov Z, Ziv Y, Kessler RC. Findings From World Mental Health Surveys of the Perceived Helpfulness of Treatment for Patients With Major Depressive Disorder. JAMA Psychiatry 2020; 77:830-841. [PMID: 32432716 PMCID: PMC7240636 DOI: 10.1001/jamapsychiatry.2020.1107] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE The perceived helpfulness of treatment is an important patient-centered measure that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking after previous unhelpful treatments. OBJECTIVE To examine the prevalence and factors associated with the 2 main components of perceived helpfulness of treatment in a representative sample of individuals with a lifetime history of DSM-IV major depressive disorder (MDD). DESIGN, SETTING, AND PARTICIPANTS This study examined the results of a coordinated series of community epidemiologic surveys of noninstitutionalized adults using the World Health Organization World Mental Health surveys. Seventeen surveys were conducted in 16 countries (8 surveys in high-income countries and 9 in low- and middle-income countries). The dates of data collection ranged from 2002 to 2003 (Lebanon) to 2016 to 2017 (Bulgaria). Participants included those with a lifetime history of treated MDD. Data analyses were conducted from April 2019 to January 2020. Data on socioeconomic characteristics, lifetime comorbid conditions (eg, anxiety and substance use disorders), treatment type, treatment timing, and country income level were collected. MAIN OUTCOMES AND MEASURES Conditional probabilities of helpful treatment after seeing between 1 and 5 professionals; persistence in help-seeking after between 1 and 4 unhelpful treatments; and ever obtaining helpful treatment regardless of number of professionals seen. RESULTS Survey response rates ranged from 50.4% (Poland) to 97.2% (Medellín, Columbia), with a pooled response rate of 68.3% (n = 117 616) across surveys. Mean (SE) age at first depression treatment was 34.8 (0.3) years, and 69.4% were female. Of 2726 people with a lifetime history of treatment of MDD, the cumulative probability (SE) of all respondents pooled across countries of helpful treatment after seeing up to 10 professionals was 93.9% (1.2%), but only 21.5% (3.2%) of patients persisted that long (ie, beyond 9 unhelpful treatments), resulting in 68.2% (1.1%) of patients ever receiving treatment that they perceived as helpful. The probability of perceiving treatment as helpful increased in association with 4 factors: older age at initiating treatment (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01-1.03), higher educational level (low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), shorter delay in initiating treatment after first onset (AOR, 0.98; 95% CI, 0.97-0.99), and medication received from a mental health specialist (AOR, 2.91; 95% CI, 2.04-4.15). Decomposition analysis showed that the first 2 of these 4 factors were associated with only the conditional probability of an individual treatment professional being perceived as helpful (age at first depression treatment: AOR, 1.02; 95% CI, 1.01-1.02; educational level: low: AOR, 0.48; 95% CI, 0.33-0.70; low-average: AOR, 0.62; 95% CI, 0.44-0.89; high-average: AOR, 0.67; 95% CI, 0.49-0.91 vs high educational level), whereas the latter 2 factors were associated with only persistence (treatment delay: AOR, 0.98; 95% CI, 0.97-0.99; treatment type: AOR, 3.43; 95% CI, 2.51-4.70). CONCLUSIONS AND RELEVANCE The probability that patients with MDD obtain treatment that they consider helpful might increase, perhaps markedly, if they persisted in help-seeking after unhelpful treatments with up to 9 prior professionals.
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Affiliation(s)
- Meredith G. Harris
- The University of Queensland School of Public Health, Herston, Queensland, Australia,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia
| | - Alan E. Kazdin
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Wai Tat Chiu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | | | - Ali Al-Hamzawi
- Al-Qadisiya University College of Medicine, Diwaniya Governorate, Iraq
| | - Jordi Alonso
- IMIM–Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain,Departament de Ciències Experimentals i de la Salut, Pompeu Fabra University, Barcelona, Spain,CIBER en Epidemiología y Salud Pública, Barcelona, Spain
| | - Yasmin Altwaijri
- Epidemiology Section, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica (LIM 23), Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Alfredo Cía
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon,Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon,Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | | | - Siobhan O’Neill
- Ulster University School of Psychology, Londonderry, United Kingdom
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, New South Wales, Australia
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - Daniel Vigo
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada,Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Bogdan Wojtyniak
- National Institute of Public Health–National Institute of Hygiene, Warsaw, Poland
| | - Zahari Zarkov
- National Center of Public Health and Analyses, Directorate of Mental Health and Prevention of Addictions, Sofia, Bulgaria
| | - Yuval Ziv
- Mental Health Services, Israeli Ministry of Health, Jerusalem, Israel
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Michener L, Aguilar-Gaxiola S, Alberti PM, Castaneda MJ, Castrucci BC, Harrison LM, Hughes LS, Richmond A, Wallerstein N. Engaging With Communities - Lessons (Re)Learned From COVID-19. Prev Chronic Dis 2020; 17:E65. [PMID: 32678059 PMCID: PMC7380298 DOI: 10.5888/pcd17.200250] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) has underscored longstanding societal differences in the drivers of health and demonstrated the value of applying a health equity lens to engage at-risk communities, communicate with them effectively, share data, and partner with them for program implementation, dissemination, and evaluation. Examples of engagement — across diverse communities and with community organizations; tribes; state and local health departments; hospitals; and universities — highlight the opportunity to apply lessons from COVID-19 for sustained changes in how public health and its partners work collectively to prevent disease and promote health, especially with our most vulnerable communities.
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Affiliation(s)
- Lloyd Michener
- Family Medicine and Community Health, Duke University School of Medicine, Durham, North Carolina.,Duke University - Family Medicine and Community Health, Box 2914 DUMC, Durham, NC 27708-0187.
| | - Sergio Aguilar-Gaxiola
- University of California, Davis, School of Medicine - Internal Medicine, Sacramento, California
| | - Philip M Alberti
- Health Equity Research and Policy, Association of American Medical Colleges, Washington, District of Columbia
| | - Manuel J Castaneda
- Director of Community Health, New Brunswick Tomorrow, New Brunswick, New Jersey
| | | | | | | | - Al Richmond
- Community-Campus Partnerships for Health, Raleigh, North Carolina
| | - Nina Wallerstein
- Center for Participatory Research, College of Population Health, University of New Mexico, Albuquerque, New Mexico
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18
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Varma DS, Strelnick AH, Bennett N, Piechowski P, Aguilar-Gaxiola S, Cottler LB. Improving community participation in clinical and translational research: CTSA Sentinel Network proof of concept study. J Clin Transl Sci 2020; 4:323-330. [PMID: 33244413 PMCID: PMC7681133 DOI: 10.1017/cts.2020.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Research participation by members of racial or ethnic minority groups continues to be less than optimum resulting in difficulties to generalization of research findings. Community-engaged research that relies on a community health worker (CHW) model has been found effective in building trust in the community, thereby motivating people to participate in health research. The Sentinel Network study aimed at testing the feasibility of utilizing the CHW model to link community members to appropriate health research studies at each of the research sites. METHODS The study was conducted at six Clinical and Translational Science Award institutions (N = 2371) across the country; 733 (30.9%) of the participants were from the University of Florida, 525 (22.0%) were from Washington University in St. Louis, 421 (17.8%) were from the University of California, Davis, 288 (12.1%) were from the University of Michigan, Ann Arbor, 250 (10.5%) were from Rochester, and 154 (6.5%) from Albert Einstein College of Medicine. Trained CHWs from each of these sites conducted regular community outreach where they administered a Health Needs Assessment, provided medical and social referrals, and linked to eligible research studies at each of those sites. A 30-day follow-up assessment was developed to track utilization of services satisfaction with the services and research study participation. RESULTS A large majority of people, especially African Americans, expressed willingness to participate in research studies. The top two health concerns reported by participants were hypertension and diabetes. CONCLUSION Findings on the rate of navigation and enrollment in research from this study indicate the effectiveness of a hybrid CHW service and research model of directly engaging community members to encourage people to participate in research.
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Affiliation(s)
- Deepthi S. Varma
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Alvin H. Strelnick
- Division of Community Health, Department of Family and Social Medicine, College of Medicine, Albert Einstein, Montefiore Medical Center, Bronx, NY, USA
| | - Nancy Bennett
- Department of Medicine, University of Rochester Medical Center School of Medicine and Dentistry, Rochester, NY, USA
| | - Patricia Piechowski
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities (CRHD), Clinical Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
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19
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Borges G, Aguilar-Gaxiola S, Andrade L, Benjet C, Cia A, Kessler RC, Orozco R, Sampson N, Stagnaro JC, Torres Y, Viana MC, Medina-Mora ME. Twelve-month mental health service use in six countries of the Americas: A regional report from the World Mental Health Surveys. Epidemiol Psychiatr Sci 2019; 29:e53. [PMID: 31452485 PMCID: PMC8061239 DOI: 10.1017/s2045796019000477] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/17/2019] [Accepted: 07/27/2019] [Indexed: 11/25/2022] Open
Abstract
AIMS To provide cross-national data for selected countries of the Americas on service utilization for psychiatric and substance use disorders, the distribution of these services among treatment sectors, treatment adequacy and factors associated with mental health treatment and adequacy of treatment. METHODS Data come from data collected from 6710 adults with 12 month mental disorder surveys across seven surveys in six countries in North (USA), Central (Mexico) and South (Argentina, Brazil, Colombia, Peru) America who were interviewed 2001-2015 as part of the World Health Organization (WHO) World Mental Health (WMH) Surveys. DSM-IV diagnoses were made with the WHO Composite International Diagnostic Interview (CIDI). Interviews also assessed service utilization by the treatment sector, adequacy of treatment received and socio-demographic correlates of treatment. RESULTS Little over one in four of respondents with any 12 month DSM-IV/CIDI disorder received any treatment. Although the vast majority (87.1%) of this treatment was minimally adequate, only 35.3% of cases received treatment that met acceptable quality guidelines. Indicators of social-advantage (high education and income) were associated with higher rates of service use and adequacy, but a number of other correlates varied across survey sites. CONCLUSIONS These results shed light on an enormous public health problem involving under-treatment of common mental disorders, although the problem is most extreme among people with social disadvantage. Promoting services that are more accessible, especially for those with few resources, is urgently needed.
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Affiliation(s)
- G. Borges
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - L. Andrade
- Núcleo de Epidemiologia Psiquiátrica – LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - C. Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - A. Cia
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - R. Orozco
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - N. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - J. C. Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Maria Carmen Viana
- Department of Social Medicine and Post-Graduate Program in Public Health, Psychiatric Epidemiology Research Center (CEPEP), Federal University of Espírito Santo (UFES), Vitória, Brazil
| | - M. E. Medina-Mora
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
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Degenhardt L, Bharat C, Glantz MD, Sampson NA, Scott K, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade LH, Bromet EJ, Bruffaerts R, Bunting B, de Girolamo G, Gureje O, Haro JM, Harris MG, He Y, de Jonge P, Karam EG, Karam GE, Kiejna A, Lee S, Lepine JP, Levinson D, Makanjuola V, Medina-Mora ME, Mneimneh Z, Navarro-Mateu F, Posada-Villa J, Stein DJ, Tachimori H, Torres Y, Zarkov Z, Chatterji S, Kessler RC. The epidemiology of drug use disorders cross-nationally: Findings from the WHO's World Mental Health Surveys. Int J Drug Policy 2019; 71:103-112. [PMID: 31255918 DOI: 10.1016/j.drugpo.2019.03.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/08/2019] [Accepted: 03/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Illicit drug use and associated disease burden are estimated to have increased over the past few decades, but large gaps remain in our knowledge of the extent of use of these drugs, and especially the extent of problem or dependent use, hampering confident cross-national comparisons. The World Mental Health (WMH) Surveys Initiative involves a standardised method for assessing mental and substance use disorders via structured diagnostic interviews in representative community samples of adults. We conducted cross-national comparisons of the prevalence and correlates of drug use disorders (DUDs) in countries of varied economic, social and cultural nature. METHODS AND FINDINGS DSM-IV DUDs were assessed in 27 WMH surveys in 25 countries. Across surveys, the prevalence of lifetime DUD was 3.5%, 0.7% in the past year. Lifetime DUD prevalence increased with country income: 0.9% in low/lower-middle income countries, 2.5% in upper-middle income countries, 4.8% in high-income countries. Significant differences in 12-month prevalence of DUDs were found across country in income groups in the entire cohort, but not when limited to users. DUDs were more common among men than women and younger than older respondents. Among those with a DUD and at least one other mental disorder, onset of the DUD was usually preceded by the 'other' mental disorder. CONCLUSIONS Substantial cross-national differences in DUD prevalence were found, reflecting myriad social, environmental, legal and other influences. Nonetheless, patterns of course and correlates of DUDs were strikingly consistent. These findings provide foundational data on country-level comparisons of DUDs.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia.
| | - Chrianna Bharat
- National Drug and Alcohol Research Centre (NDARC), UNSW Sydney, Sydney, Australia
| | - Meyer D Glantz
- Department of Epidemiology, Services, and Prevention Research (DESPR), National Institute on Drug Abuse (NIDA), National Institute of Health (NIH), Bethesda, MD, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Kate Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Carmen C W Lim
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia; Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | | | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura H Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | | | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Meredith G Harris
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Queensland, Australia; School of Public Health, The University of Queensland, QLD, Australia
| | - Yanling He
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands; Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges E Karam
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon
| | - Andrzej Kiejna
- Wroclaw Medical University, Wroclaw, Poland; University of Lower Silesia, Wroclaw, Poland
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris, Paris, France; Universités Paris Descartes-Paris Diderot, Paris, France; Institut National de la Sante et de la Recherche Medicale (INSERM) UMR-S 1144, Paris, France
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Victor Makanjuola
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria; University College Hospital, Ibadan, Nigeria
| | | | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental (UDIF-SM), Servicio Murciano de Salud, Murcia, Spain; IMIB-Arrixaca, Murcia, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Dan J Stein
- Department of Psychiatry & Mental Health and South African Medical Council Research Unit on Risk and Resilience in Mental Disorders, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Hisateru Tachimori
- National Institute of Mental Health, National Center for Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Zahari Zarkov
- Directorate Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Somnath Chatterji
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Richmond A, Aguilar-Gaxiola S, Perez-Stable EJ, Menon U, Hughes-Halbert C, Watson KS, Greer-Smith R, Clyatt C, Tobin JN, Wilkins CH. Proceedings of the 2017 Advancing the Science of Community Engaged Research (CEnR) Conference. BMC Proc 2019; 13:3. [PMID: 31019549 PMCID: PMC6474049 DOI: 10.1186/s12919-019-0164-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To address an urgent need to advance the field of community engaged research, faculty at Vanderbilt University Medical Center and Meharry Medical College organized the national meeting "Advancing the Science of Community Engaged Research (CEnR): Innovative & Effective Methods of Stakeholder Engagement in Translational Research, Washington, DC September 14-15, 2017 (See Additional file 1). These meetings brought together a diverse group of stakeholders to share community engaged research evidence and practical knowledge for implementing new and enhancing existing research programs. The conference series' goals were: 1) to expand the scientific basis for the community engaged research field by convening researchers, community partners, patient advocacy organizations, and others to share innovative methods and strategies; 2) to engage community representatives and patient advocates in the development of new approaches in community engaged research by meaningfully involving them in the planning, as speakers and presenters, and as conference participants; and 3) to catalyze innovative community engaged research using interactive meeting methods that promote learning, support collective problem solving, and encourage new conceptual frameworks. These conferences have advanced community engagement across the translational research spectrum in biomedical research. For the 2017 meeting, described here, the overarching theme was Innovative and Effective Methods of Stakeholder Engagement in Translational Research. METHODS The forum was attended by over 210 participants. This conference used novel approaches to fulfill its objectives of participant diversity, meaningful stakeholder engagement, and eliciting varied distinct perspectives to advance the science of community engaged research. Innovative strategies for the conference included: Think Tanks focused on emerging community engaged research topics or topics in need of urgent attention. These dynamic group sessions provided for freely sharing ideas with the purpose of creating change and facilitating new research collaborations. Learning Labs offered unique opportunities to gain practical knowledge regarding innovative methods in community engaged research. Learning Labs also facilitated the wide broadcast of locally successful engagement methods with the goal of speeding the uptake and implementation of community engaged methods. Travel Scholarships were provided for twenty community and patient representatives to participate in the conference. The lack of travel funds was a significant barrier to stakeholder participation in prior community engaged research meetings. The scholarships expanded the role of community and patient representatives in setting research priorities and promoting methods development. Meaningful Engagement meant that community members and patients participated in decision making on all aspects of the conference planning, including the selection of themes, topics, and speakers, and were fully integrated into the conference as speakers, panelists, and moderators. CONCLUSIONS Community and stakeholder engagement can directly impact research by enhancing clinical trial design, increasing relevance, and increasing recruitment, accrual and retention (Staley K.: Exploring Impact: Public 53 Involvement in NHS, Public Health and Social Care Research - INVOLVE.; 2009, Johnson et al Clin Transl Sci 8:388-54 390, 2015, Joosten et al Acad Med 90:1646-1650, 2015). The 2017 Advancing the Science of Community Engaged Research meeting, Innovative and Effective Methods of Stakeholder Engagement in Translational Research facilitated meaningful engagement of diverse stakeholder groups including racial and ethnic minorities, community and patient representatives, and junior investigators. Of 210 attendees, 72 completed the evaluation, and, of those, 36% self-affiliated as community members, and 21% as patient/caregiver advocacy, faith-based, or tribal organization members. This conference 1) represented a step toward expanding the scientific basis for the community engaged research (CEnR) field; 2) catalyzed innovative community engaged research; and 3) enhanced the reach and impact of the scientific developments emerging from pioneering work in community engagement.
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Affiliation(s)
- Al Richmond
- Community Campus Partnerships for Health, Raleigh, NC 27605 USA
| | - Sergio Aguilar-Gaxiola
- Clinical Internal Medicine, School of Medicine, University of California, Davis, Sacramento, CA 95817 USA
| | - Eliséo J. Perez-Stable
- National Institute on Minority Health and Health Disparities, Bethesda, MD 20892-5465 USA
| | - Usha Menon
- University of South Florida, Tampa, FL 33612 USA
| | | | - Karriem S. Watson
- University of Illinois at Chicago Cancer Center, Chicago, IL 60612 USA
| | | | - Courtney Clyatt
- Patient-Centered Outcomes Research Institute, Washington, DC 20036 USA
| | | | - Consuelo H. Wilkins
- Vice President for Health Equity, Vanderbilt University Medical Center, Executive Director, Meharry-Vanderbilt Alliance, 1005 Dr. D.B. Todd Jr. Boulevard, Nashville, TN 37208 USA
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22
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Scott KM, Saha S, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bromet EJ, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, de Jonge P, Degenhardt L, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kovess-Masfety V, Lee S, Lepine JP, Mneimneh Z, Navarro-Mateu F, Piazza M, Posada-Villa J, Sampson NA, Stagnaro JC, Kessler RC, McGrath JJ. Psychotic experiences and general medical conditions: a cross-national analysis based on 28 002 respondents from 16 countries in the WHO World Mental Health Surveys. Psychol Med 2018; 48:2730-2739. [PMID: 29478433 PMCID: PMC6109618 DOI: 10.1017/s0033291718000363] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Previous work has identified associations between psychotic experiences (PEs) and general medical conditions (GMCs), but their temporal direction remains unclear as does the extent to which they are independent of comorbid mental disorders. METHODS In total, 28 002 adults in 16 countries from the WHO World Mental Health (WMH) Surveys were assessed for PEs, GMCs and 21 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders. Discrete-time survival analyses were used to estimate the associations between PEs and GMCs with various adjustments. RESULTS After adjustment for comorbid mental disorders, temporally prior PEs were significantly associated with subsequent onset of 8/12 GMCs (arthritis, back or neck pain, frequent or severe headache, other chronic pain, heart disease, high blood pressure, diabetes and peptic ulcer) with odds ratios (ORs) ranging from 1.3 [95% confidence interval (CI) 1.1-1.5] to 1.9 (95% CI 1.4-2.4). In contrast, only three GMCs (frequent or severe headache, other chronic pain and asthma) were significantly associated with subsequent onset of PEs after adjustment for comorbid GMCs and mental disorders, with ORs ranging from 1.5 (95% CI 1.2-1.9) to 1.7 (95% CI 1.2-2.4). CONCLUSIONS PEs were associated with the subsequent onset of a wide range of GMCs, independent of comorbid mental disorders. There were also associations between some medical conditions (particularly those involving chronic pain) and subsequent PEs. Although these findings will need to be confirmed in prospective studies, clinicians should be aware that psychotic symptoms may be risk markers for a wide range of adverse health outcomes. Whether PEs are causal risk factors will require further research.
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Affiliation(s)
- Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Sukanta Saha
- Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Carmen C.W. Lim
- Queensland Centre for Mental Health Research and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School | Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, NL
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris; Universités Paris Descartes-Paris Diderot; INSERM UMR-S 1144, Paris, France
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Marina Piazza
- Universidad Cayetano Heredia, Lima, Peru; National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John J. McGrath
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia; and National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
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Cia AH, Stagnaro JC, Aguilar-Gaxiola S, Sustas S, Serfaty E, Nemirovsky M, Kessler RC, Benjet C. Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina. ACTA ACUST UNITED AC 2018; 41:238-244. [PMID: 30427387 PMCID: PMC6794125 DOI: 10.1590/1516-4446-2018-0036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 06/20/2018] [Indexed: 12/03/2022]
Abstract
Objective: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). Methods: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. Results: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. Conclusions: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.
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Affiliation(s)
- Alfredo H Cia
- Centro de Investigaciones Médicas en Ansiedad, Buenos Aires, Argentina
| | - Juan C Stagnaro
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Sebastián Sustas
- Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Edith Serfaty
- Centro de Estudios Epidemiológicos, Buenos Aires, Argentina
| | | | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Corina Benjet
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
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Alonso J, Saha S, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, Benjet C, Bromet EJ, Degenhardt L, de Girolamo G, Esan O, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Karam G, Kovess-Masfety V, Lepine JP, Lee S, Mneimneh Z, Navarro-Mateu F, Posada-Villa J, Sampson NA, Scott KM, Stagnaro JC, Ten Have M, Viana MC, Kessler RC, McGrath JJ. The association between psychotic experiences and health-related quality of life: a cross-national analysis based on World Mental Health Surveys. Schizophr Res 2018; 201:46-53. [PMID: 29778294 PMCID: PMC6371397 DOI: 10.1016/j.schres.2018.04.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/27/2018] [Accepted: 04/29/2018] [Indexed: 02/06/2023]
Abstract
Psychotic experiences (PEs) are associated with a range of mental and physical disorders, and disability, but little is known about the association between PEs and aspects of health-related quality of life (HRQoL). We aimed to investigate the association between PEs and five HRQoL indicators with various adjustments. Using data from the WHO World Mental Health surveys (n = 33,370 adult respondents from 19 countries), we assessed for PEs and five HRQoL indicators (self-rated physical or mental health, perceived level of stigma (embarrassment and discrimination), and social network burden). Logistic regression models that adjusted for socio-demographic characteristics, 21 DSM-IV mental disorders, and 14 general medical conditions were used to investigate the associations between the variables of interest. We also investigated dose-response relationships between PE-related metrics (number of types and frequency of episodes) and the HRQoL indicators. Those with a history of PEs had increased odds of poor perceived mental (OR = 1.5, 95% CI = 1.2-1.9) and physical health (OR = 1.3, 95% CI = 1.0-1.7) after adjustment for the presence of any mental or general medical conditions. Higher levels of perceived stigma and social network burden were also associated with PEs in the adjusted models. Dose-response associations between PE type and frequency metrics and subjective physical and mental health were non-significant, except those with more PE types had increased odds of reporting higher discrimination (OR = 2.2, 95% CI = 1.3-3.5). Our findings provide novel insights into how those with PEs perceive their health status.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Sukanta Saha
- Queensland Centre for Mental Health Research, University of Queensland, St. Lucia, Queensland, Australia; Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia
| | - Carmen C W Lim
- Queensland Centre for Mental Health Research, University of Queensland, St. Lucia, Queensland, Australia; Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia
| | | | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muniz, Mexico City, Mexico
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
| | - Oluyomi Esan
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Josep M Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Balamand University, Faculty of Medicine, Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University,Paris, France
| | - Jean-Pierre Lepine
- Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris; Universités Paris Descartes-Paris Diderot; INSERM UMR-S 1144, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Maria Carmen Viana
- Department of Social Medicine, Postgraduate Program in Public Health, Federal University of Espírito Santo, Vitoria, Brazil
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John J McGrath
- Queensland Centre for Mental Health Research, University of Queensland, St. Lucia, Queensland, Australia; Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia; National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark..
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25
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Stagnaro JC, Cía A, Vázquez N, Vommaro H, Nemirovsky M, Serfaty E, Sustas SE, Medina Mora ME, Benjet C, Aguilar-Gaxiola S, Kessler R. [Epidemiological study of mental health in the general population of Argentina]. Vertex 2018; XXIX:275-299. [PMID: 30785970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In this paper we report the findings of the first "Epidemiological study of mental health in the general population of Argentina" in the framework of the World Mental Health Survey Initiative WHO / Harvard, in collaboration with the Faculty of Medicine of the University of Buenos Aires and the Asociación de Psiquiatras Argentinos (APSA) with funding from the Ministry of Health. Methodology: A multistage probabilistic household survey was conducted using the Composite International Diagnostic Interview (CIDI). The survey was conducted on 3,927 people aged 18 and over (no age limit), with fixed residence in one of the eight largest urban areas in the country (Buenos Aires, Córdoba, Corrientes-Resistencia, Mendoza, Neuquén, Rosario, Salta and Tucumán), representing approximately 50.1% of the adults living in the country. The response rate was 77%. Results: The lifetime prevalence of any mental disorder in the general population of Argentina over 18 years of age was 29.1% and the projected life risk up to 75 years of age was 37.1%. The disorders with the highest life prevalence were Major Depressive Disorder (8.7%), Alcohol Abuse Disorder (8.1%) and Specific Phobia (6.8%). Anxiety Disorders were the most prevalent group (16.4%), followed by Mood Disorders (12.3%), Substance Disorders (10.4%), and Impulse Control Disorders (2.5%). The prevalence in the last 12 months of any mental disorder was 14.8%, a quarter of wich were classified as severe. 11.6% received treatment in the previous 12 months and only 30.2% of those who suffered a severe disorder received it. The results provide essential data for health planning and implementation and the training of the mental health workforce.
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Affiliation(s)
- Juan C Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
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Abstract
The paper presents an overview of the WHO World Mental Health (WMH) Survey Initiative and summarizes recent WMH results regarding the prevalence and societal costs of mental disorders. The WMH surveys are representative community surveys that were carried out in 28 countries throughout the world aimed at providing information to mental health policy makers about the prevalence, burden, and unmet need for treatment of common mental disorders. Results show that mental disorders are commonly occurring in all participating countries. The inter-quartile range (IQR: 25(th)-75(th) percentiles) of lifetime DSM-IV disorder prevalence estimates (combining anxiety, mood, disruptive behavior, and substance disorders) is 18.1-36.1%. The IQR of 12-month prevalence estimates is 9.8-19.1%. Analysis of age-of-onset reports shows that many mental disorders begin in childhood-adolescence and have significant adverse effects on subsequent role transitions. Adult mental disorders are found in the WMH data to be associated with high levels of role impairment. Despite this burden, the majority of mental disorders go untreated. Although these results suggest that expansion of treatment could be cost-effective from both the employer perspective and the societal perspective, treatment effectiveness trials are needed to confirm this suspicion. The WMH results regarding impairments are being used to target several such interventions.
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27
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de Jonge P, Wardenaar KJ, Lim CCW, Aguilar-Gaxiola S, Alonso J, Andrade LH, Bunting B, Chatterji S, Ciutan M, Gureje O, Karam EG, Lee S, Medina-Mora ME, Moskalewicz J, Navarro-Mateu F, Pennell BE, Piazza M, Posada-Villa J, Torres Y, Kessler RC, Scott K. The cross-national structure of mental disorders: results from the World Mental Health Surveys. Psychol Med 2018; 48:2073-2084. [PMID: 29254513 PMCID: PMC6008201 DOI: 10.1017/s0033291717003610] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The patterns of comorbidity among mental disorders have led researchers to model the underlying structure of psychopathology. While studies have suggested a structure including internalizing and externalizing disorders, less is known with regard to the cross-national stability of this model. Moreover, little data are available on the placement of eating disorders, bipolar disorder and psychotic experiences (PEs) in this structure. METHODS We evaluated the structure of mental disorders with data from the World Health Organization Composite International Diagnostic Interview, including 15 lifetime mental disorders and six PEs. Respondents (n = 5478-15 499) were included from 10 high-, middle- and lower middle-income countries across the world aged 18 years or older. Confirmatory factor analyses (CFAs) were used to evaluate and compare the fit of different factor structures to the lifetime disorder data. Measurement invariance was evaluated with multigroup CFA (MG-CFA). RESULTS A second-order model with internalizing and externalizing factors and fear and distress subfactors best described the structure of common mental disorders. MG-CFA showed that this model was stable across countries. Of the uncommon disorders, bipolar disorder and eating disorder were best grouped with the internalizing factor, and PEs with a separate factor. CONCLUSIONS These results indicate that cross-national patterns of lifetime common mental-disorder comorbidity can be explained with a second-order underlying structure that is stable across countries and can be extended to also cover less common mental disorders.
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Affiliation(s)
- Peter de Jonge
- Developmental Psychology,Department of Psychology,Rijksuniversiteit Groningen,Groningen,Netherlands
| | - Klaas J Wardenaar
- Department of Psychiatry,Interdisciplinary Center Psychopathology and Emotion Regulation,University Medical Center Groningen,Groningen,Netherlands
| | - Carmen C W Lim
- Department of Psychological Medicine,University of Otago,Dunedin, Otago,New Zealand
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities,UC Davis Health System,Sacramento, California,USA
| | - Jordi Alonso
- Health Services Research Unit,IMIM-Hospital del Mar Medical Research Institute,Barcelona,Spain
| | - Laura Helena Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23,Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade,de São Paulo,Brazil
| | | | - Somnath Chatterji
- Department of Information,Evidence and Research, World Health Organization,Geneva,Switzerland
| | - Marius Ciutan
- National School of Public Health,Management and Development,Bucharest,Romania
| | - Oye Gureje
- Department of Psychiatry,University College Hospital,Ibadan,Nigeria
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology,St George Hospital University Medical Center, Balamand University,Faculty of Medicine,Beirut,Lebanon
| | - Sing Lee
- Department of Psychiatry,Chinese University of Hong Kong,Tai Po,Hong Kong
| | | | | | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud; IMIB-Arrixaca; CIBERESP-Murcia,Murcia,Spain
| | - Beth-Ellen Pennell
- Survey Research Center,Institute for Social Research,University of Michigan,Ann Arbor, Michigan,USA
| | | | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences,Bogota,Colombia
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University,Medellin,Colombia
| | - Ronald C Kessler
- Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA
| | - Kate Scott
- Department of Psychological Medicine,University of Otago,Dunedin, Otago,New Zealand
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28
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Evans-Lacko S, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bruffaerts R, Chiu W, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hu C, Karam EG, Kawakami N, Lee S, Lund C, Kovess-Masfety V, Levinson D, Navarro-Mateu F, Pennell BE, Sampson N, Scott K, Tachimori H, ten Have M, Viana MC, Williams DR, Wojtyniak BJ, Zarkov Z, Kessler RC, Chatterji S, Thornicroft G. Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys. Psychol Med 2018; 48:1560-1571. [PMID: 29173244 PMCID: PMC6878971 DOI: 10.1017/s0033291717003336] [Citation(s) in RCA: 218] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data. METHODS Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI). RESULTS Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes). CONCLUSIONS The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.
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Affiliation(s)
- S. Evans-Lacko
- Kings College London, Institute of Psychiatry, Psychology
& Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom
- PSSRU, London School of Economics and Political Science,
Houghton Street, London WC2A 2AE, United Kingdom
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health
System, Sacramento, California, USA
| | - A. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya
governorate, Iraq
| | - J. Alonso
- Health Services Research Unit, IMIM-Hospital del Mar
Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF),
Barcelona, Spain; and CIBER en Epidemiología y Salud Pública
(CIBERESP), Barcelona, Spain
| | - C. Benjet
- Department of Epidemiologic and Psychosocial Research,
National Institute of Psychiatry Ramón de la Fuente Muniz, Mexico City,
Mexico
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke
Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - W.T. Chiu
- Department of Health Care Policy, Harvard Medical School,
Boston, Massachusetts, USA
| | - S. Florescu
- National School of Public Health, Management and
Development, Bucharest, Romania
| | - G. de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry,
Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical
Research Centre, Via Pilastroni 4, Brescia, Italy
| | - O. Gureje
- Department of Psychiatry, University College Hospital,
Ibadan, Nigeria
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM,
Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Y. He
- Shanghai Mental Health Center, Shanghai Jiao Tong
University, School of Medicine, Shanghai, China
| | - C. Hu
- Shenzhen Institute of Mental Health & Shenzhen
Kangning Hospital, Shenzhen, China
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, St
George Hospital University Medical Center, Balamand University, Faculty of Medicine,
Beirut, Lebanon; Institute for Development, Research, Advocacy and Applied Care
(IDRAAC), Beirut, Lebanon
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The
University of Tokyo, Tokyo, Japan
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong
Kong, Tai Po, Hong Kong
| | - C. Lund
- Kings College London, Institute of Psychiatry, Psychology
& Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom
- Alan J Flisher Centre for Public Mental Health,
Department of Psychiatry and Mental Health, University of Cape Town, South
Africa
| | - V. Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP),
EA 4057, Paris Descartes University, Paris, France
| | - D. Levinson
- Mental Health Services, Ministry of Health, Jerusalem,
Israel
| | - F. Navarro-Mateu
- UDIF-SM, Subdirección General de
Planificación, Innovación y Cronicidad, Servicio Murciano de Salud.
IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - B. E. Pennell
- Survey Research Center, Institute for Social Research,
University of Michigan, Ann Arbor, Michigan, USA
| | - N.A. Sampson
- Department of Health Care Policy, Harvard Medical School,
Boston, Massachusetts, USA
| | - K.M. Scott
- Department of Psychological Medicine, University of
Otago, Dunedin, Otago, New Zealand
| | - H. Tachimori
- National Institute of Mental Health, National Center for
Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - M. ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health
and Addiction, Utrecht, Netherlands
| | - M. C. Viana
- Department of Social Medicine, Federal University of
Espírito Santo, Vitoria, Brazil
| | - D. R. Williams
- Department of Society, Human Development, and Health,
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - B. J. Wojtyniak
- Centre of Monitoring and Analyses of Population Health,
National Institute of Public Health-National Institute of Hygiene, Warsaw,
Poland
| | - Z. Zarkov
- Directorate of Mental Health, National Center of Public
Health and Analyses, Sofia, Bulgaria
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School,
Boston, Massachusetts, USA
| | - S. Chatterji
- Department of Information, Evidence and Research, World
Health Organization, Geneva, Switzerland
| | - G. Thornicroft
- Kings College London, Institute of Psychiatry, Psychology
& Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom
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29
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Degenhardt L, Saha S, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade LH, Bromet EJ, Bruffaerts R, Caldas-de-Almeida JM, de Girolamo G, Florescu S, Gureje O, Haro JM, Karam EG, Karam G, Kovess-Masfety V, Lee S, Lepine JP, Makanjuola V, Medina-Mora ME, Mneimneh Z, Navarro-Mateu F, Piazza M, Posada-Villa J, Sampson NA, Scott KM, Stagnaro JC, Have MT, Kendler KS, Kessler RC, McGrath JJ. The associations between psychotic experiences and substance use and substance use disorders: findings from the World Health Organization World Mental Health surveys. Addiction 2018; 113:924-934. [PMID: 29284197 PMCID: PMC5895500 DOI: 10.1111/add.14145] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/24/2017] [Accepted: 12/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS Prior research has found bidirectional associations between psychotic experiences (PEs) and selected substance use disorders. We aimed to extend this research by examining the bidirectional association between PEs and various types of substance use (SU) and substance use disorders (SUDs), and the influence of antecedent mental disorders on these associations. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS We used data from the World Health Organization World Mental Health surveys. A total of 30 902 adult respondents across 18 countries were assessed for (a) six types of life-time PEs, (b) a range of types of SU and DSM-IV SUDs and (c) mental disorders using the Composite International Diagnostic Interview. Discrete-time survival analyses based on retrospective age-at-onset reports examined the bidirectional associations between PEs and SU/SUDs controlling for antecedent mental disorders. FINDINGS After adjusting for demographics, comorbid SU/SUDs and antecedent mental disorders, those with prior alcohol use disorders [odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.2-2.0], extra-medical prescription drug use (OR = 1.5, 95% CI = 1.1-1.9), alcohol use (OR = 1.4, 95% CI = 1.1-1.7) and tobacco use (OR = 1.3, 95% CI = 1.0-1.8) had increased odds of subsequent first onset of PEs. In contrast, those with temporally prior PEs had increased odds of subsequent onset of tobacco use (OR = 1.5, 95% CI = 1.2-1.9), alcohol use (OR = 1.3, 95% CI = 1.1-1.6) or cannabis use (OR = 1.3, 95% CI = 1.0-1.5) as well as of all substance use disorders (ORs ranged between 1.4 and 1.5). There was a dose response relationship between both count and frequency of PEs and increased subsequent odds of selected SU/SUDs. CONCLUSIONS Associations between psychotic experiences (PEs) and substance use/substance use disorders (SU/SUDs) are often bidirectional, but not all types of SU/SUDs are associated with PEs. These findings suggest that it is important to be aware of the presence of PEs within those with SUDs or at risk of SUDs, given the plausibility that they may each impact upon the other.
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Affiliation(s)
- Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Sukanta Saha
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Carmen C. W. Lim
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura H. Andrade
- Núcleo de Epidemiologia Psiquiátrica - LIM 23, Instituto de Psiquiatria Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - José M. Caldas-de-Almeida
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), NOVA Medical School
- Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Leban on; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Georges Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Leban on; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Viviane Kovess-Masfety
- EHESP Dpt MéTis Epidémiologie et biostatistiques pour la décision en santé publique /Laboratoire Psychopathologie et Processus de Santé (EA 4057) Université Paris Descartes EHESP School for Public Health; Dpt Health Epidemiology and biostatistics for decision making in public health / EA 4057 Paris Descartes University
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière-Fernand Widal, Assistance Publique Hôpitaux de Paris; Universités Paris Descartes-Paris Diderot; INSERM UMR-S 1144, Paris, France
| | - Victor Makanjuola
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | | | - Zeina Mneimneh
- Survey Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Marina Piazza
- Universidad Cayetano Heredia, Lima, Peru; National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Juan C. Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | | | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John J. McGrath
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia; and National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
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Kovess-Masfety V, Saha S, Lim C, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Borges G, de Girolamo G, de Jonge P, Demyttenaere K, Florescu S, Haro J, Hu C, Karam E, Kawakami N, Lee S, Lepine J, Navarro-Mateu F, Stagnaro J, ten Have M, Viana M, Kessler R, McGrath J. Psychotic experiences and religiosity: data from the WHO World Mental Health Surveys. Acta Psychiatr Scand 2018; 137:306-315. [PMID: 29453789 PMCID: PMC6839106 DOI: 10.1111/acps.12859] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Religiosity is often associated with better health outcomes. The aim of the study was to examine associations between psychotic experiences (PEs) and religiosity in a large, cross-national sample. METHODS A total of 25 542 adult respondents across 18 countries from the WHO World Mental Health Surveys were assessed for PEs, religious affiliation and indices of religiosity, DSM-IV mental disorders and general medical conditions. Logistic regression models were used to estimate the association between PEs and religiosity with various adjustments. RESULTS Of 25 542 included respondents, 85.6% (SE = 0.3) (n = 21 860) respondents reported having a religious affiliation. Overall, there was no association between religious affiliation status and PEs. Within the subgroup having a religious affiliation, four of five indices of religiosity were significantly associated with increased odds of PEs (odds ratios ranged from 1.3 to 1.9). The findings persisted after adjustments for mental disorders and/or general medical conditions, as well as religious denomination type. There was a significant association between increased religiosity and reporting more types of PEs. CONCLUSIONS Among individuals with religious affiliations, those who reported more religiosity on four of five indices had increased odds of PEs. Focussed and more qualitative research will be required to unravel the interrelationship between religiosity and PEs.
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Affiliation(s)
- V. Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - S. Saha
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - C.C.W. Lim
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - A. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - J. Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - G. Borges
- National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - G. de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
| | - P. de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, NL
| | - K. Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - S. Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - J.M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - C. Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - E.G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - J.P. Lepine
- Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris; Universités Paris Descartes-Paris Diderot;INSERM UMR-S 1144, Paris, France
| | - F. Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - J.C. Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - M. ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - M.C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - R.C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - J.J. McGrath
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia; and National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
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Alonso J, Liu Z, Evans-Lacko S, Sadikova E, Sampson N, Chatterji S, Abdulmalik J, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Bruffaerts R, Cardoso G, Cia A, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, de Jonge P, Karam EG, Kawakami N, Kovess-Masfety V, Lee S, Levinson D, Medina-Mora ME, Navarro-Mateu F, Pennell BE, Piazza M, Posada-Villa J, Have MT, Zarkov Z, Kessler RC, Thornicroft G. Treatment gap for anxiety disorders is global: Results of the World Mental Health Surveys in 21 countries. Depress Anxiety 2018; 35:195-208. [PMID: 29356216 PMCID: PMC6008788 DOI: 10.1002/da.22711] [Citation(s) in RCA: 231] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 11/20/2017] [Accepted: 11/25/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Anxiety disorders are a major cause of burden of disease. Treatment gaps have been described, but a worldwide evaluation is lacking. We estimated, among individuals with a 12-month DSM-IV (where DSM is Diagnostic Statistical Manual) anxiety disorder in 21 countries, the proportion who (i) perceived a need for treatment; (ii) received any treatment; and (iii) received possibly adequate treatment. METHODS Data from 23 community surveys in 21 countries of the World Mental Health (WMH) surveys. DSM-IV mental disorders were assessed (WHO Composite International Diagnostic Interview, CIDI 3.0). DSM-IV included posttraumatic stress disorder among anxiety disorders, while it is not considered so in the DSM-5. We asked if, in the previous 12 months, respondents felt they needed professional treatment and if they obtained professional treatment (specialized/general medical, complementary alternative medical, or nonmedical professional) for "problems with emotions, nerves, mental health, or use of alcohol or drugs." Possibly adequate treatment was defined as receiving pharmacotherapy (1+ months of medication and 4+ visits to a medical doctor) or psychotherapy, complementary alternative medicine or nonmedical care (8+ visits). RESULTS Of 51,547 respondents (response = 71.3%), 9.8% had a 12-month DSM-IV anxiety disorder, 27.6% of whom received any treatment, and only 9.8% received possibly adequate treatment. Of those with 12-month anxiety only 41.3% perceived a need for care. Lower treatment levels were found for lower income countries. CONCLUSIONS Low levels of service use and a high proportion of those receiving services not meeting adequacy standards for anxiety disorders exist worldwide. Results suggest the need for improving recognition of anxiety disorders and the quality of treatment.
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Affiliation(s)
- Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Zhaorui Liu
- Institute of Mental Health, Peking University, Beijing, China
| | - Sara Evans-Lacko
- Kings College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom,PSSRU, London School of Economics and Political Science, London, United Kingdom
| | - Ekaterina Sadikova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Somnath Chatterji
- Department of Information, Evidence and Research,World Health Organization, Geneva, Switzerland
| | - Jibril Abdulmalik
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Graça Cardoso
- Department of Mental Health, Faculdades de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Alfredo Cia
- Anxiety Disorders Center, Buenos Aires, Argentina
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS-St. John of God Clinical Research Centre, Brescia, Italy
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Yanling He
- Shanghai Mental Health Center, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, Netherlands,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Balamand University, Faculty of Medicine, Beirut, Lebanon,Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | | | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Beth-Ellen Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Marina Piazza
- Universidad Cayetano Heredia, Lima, Peru; National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Zahari Zarkov
- Directorate of Mental Health, National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Graham Thornicroft
- Kings College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
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Rosellini AJ, Liu H, Petukhova MV, Sampson NA, Aguilar-Gaxiola S, Alonso J, Borges G, Bruffaerts R, Bromet EJ, de Girolamo G, de Jonge P, Fayyad J, Florescu S, Gureje O, Haro JM, Hinkov H, Karam EG, Kawakami N, Koenen KC, Lee S, Lépine JP, Levinson D, Navarro-Mateu F, Oladeji BD, O’Neill S, Pennell BE, Piazza M, Posada-Villa J, Scott KM, Stein DJ, Torres Y, Viana MC, Zaslavsky AM, Kessler RC. Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys. Psychol Med 2018; 48:437-450. [PMID: 28720167 PMCID: PMC5758426 DOI: 10.1017/s0033291717001817] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors. METHODS The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD. RESULTS 20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2-0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66-55% v. 43%) and later-recovery (75-68% v. 39%). CONCLUSIONS We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.
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Affiliation(s)
- A. J. Rosellini
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - H. Liu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - M. V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - N. A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA
| | - J. Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University (UPF), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - G. Borges
- National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - R. Bruffaerts
- Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - E. J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - P. de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - J. Fayyad
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - S. Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - O. Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - H. Hinkov
- National Center for Public Health and Analyses, Sofia, Bulgaria
| | - E. G. Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - J. P. Lépine
- Hôpital Lariboisière-Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes-Paris Diderot, INSERM UMR-S 1144, Paris, France
| | - D. Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - F. Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | - B. D. Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - S. O’Neill
- School of Psychology, Ulster University, Londonderry, UK
| | - B.-E. Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - M. Piazza
- Universidad Cayetano Heredia, National Institute of Health, Lima, Peru
| | | | - K. M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - A. M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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Saldarriaga W, Forero-Forero JV, González-Teshima LY, Fandiño-Losada A, Isaza C, Tovar-Cuevas JR, Silva M, Choudhary NS, Tang HT, Aguilar-Gaxiola S, Hagerman RJ, Tassone F. Genetic cluster of fragile X syndrome in a Colombian district. J Hum Genet 2018; 63:509-516. [PMID: 29379191 DOI: 10.1038/s10038-017-0407-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 12/05/2017] [Accepted: 12/15/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Fragile X syndrome (FXS) is the most common cause of inherited intellectual disabilities and autism. The reported prevalence of the full mutation (FM) gene FMR1 in the general population is 0.2-0.4 per 1000 males and 0.125-0.4 per 1000 females. Population screening for FMR1 expanded alleles has been performed in newborns and in an adult population. However, it has never been carried out in an entire town. Ricaurte is a Colombian district with 1186 habitants, with a high prevalence of FXS, which was first described by cytogenetic techniques in 1999. METHODS Using a PCR-based approach, screening for FXS was performed on blood spot samples obtained from 926 (502 males and 424 females) inhabitants from Ricaurte, accounting for 78% of total population. RESULTS A high prevalence of carriers of the expanded allele was observed in all FXS mutation categories. Using the Bayesian methods the carrier frequency of FM was 48.2 (95% Credibility Region CR: 36.3-61.5) per 1000 males and 20.5 (95% CR:13.5-28.6) per 1000 females; the frequency of premutation carrier was 14.1 (95% RC: 8.0-21.7) per 1000 males (95% RC: 8.0-21.7 per 1000 males) and 35.9 (95% RC: 26.5-46.2) per 1000 for females (95% RC: 26.5-46.2 per 1000 females), and gray zone carrier was 13.4 (95% RC: 7.4-20.7) per 1000 males (95% RC: 7.4-20.7 per 1000 males) and 42.2 (95% RC: 32.2-53.8) per 1000 for females (95% RC: 32.2-53.8 per 1000 females). Differences in carrier frequencies were observed for premutation and FM alleles between natives and non-natives. CONCLUSIONS This study shows that in Ricaurte the carrier frequencies of FMR1 expanded alleles (premutations and FMs) are higher than those reported in the literature, suggesting that Ricaurte constitutes a genetic cluster of FXS.
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Affiliation(s)
- Wilmar Saldarriaga
- School of Basics Sciences, Universidad del Valle, Cali, Colombia. .,School of Medicine, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia. .,Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia.
| | - Jose Vicente Forero-Forero
- School of Medicine, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia.,Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia
| | - Laura Yuriko González-Teshima
- School of Medicine, Universidad del Valle, Hospital Universitario del Valle, Cali, Colombia.,Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia
| | - Andrés Fandiño-Losada
- Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia.,School of Public Health, Universidad del Valle, Cali, Colombia
| | - Carolina Isaza
- School of Basics Sciences, Universidad del Valle, Cali, Colombia.,Research Group in Congenital & Perinatal Malformations, Dysmorphology and Clinical Genetics (MACOS), Universidad del Valle, Cali, Colombia
| | | | - Marisol Silva
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Nimrah S Choudhary
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Hiu-Tung Tang
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA
| | - Sergio Aguilar-Gaxiola
- Department of Internal Medicine, University of California, Davis Health, Sacramento, CA, USA
| | - Randi J Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, CA, USA.,Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA, USA
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California, Davis, CA, USA. .,Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California, Davis Medical Center, Sacramento, CA, USA.
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Viana MC, Lim CCW, Garcia Pereira F, Aguilar-Gaxiola S, Alonso J, Bruffaerts R, de Jonge P, Caldas-de-Almeida JM, O'Neill S, Stein DJ, Al-Hamzawi A, Benjet C, Cardoso G, Florescu S, de Girolamo G, Haro JM, Hu C, Kovess-Masfety V, Levinson D, Piazza M, Posada-Villa J, Rabczenko D, Kessler RC, Scott KM. Previous Mental Disorders and Subsequent Onset of Chronic Back or Neck Pain: Findings From 19 Countries. J Pain 2018; 19:99-110. [PMID: 29031785 PMCID: PMC6839827 DOI: 10.1016/j.jpain.2017.08.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/26/2017] [Accepted: 08/29/2017] [Indexed: 11/26/2022]
Abstract
Associations between depression/anxiety and pain are well established, but its directionality is not clear. We examined the associations between temporally previous mental disorders and subsequent self-reported chronic back/neck pain onset, and investigated the variation in the strength of associations according to timing of events during the life course, and according to gender. Data were from population-based household surveys conducted in 19 countries (N = 52,095). Lifetime prevalence and age of onset of 16 mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the occurrence and age of onset of back/neck pain were assessed using the Composite International Diagnostic Interview. Survival analyses estimated the associations between first onset of mental disorders and subsequent back/neck pain onset. All mental disorders were positively associated with back/neck pain in bivariate analyses; most (12 of 16) remained so after adjusting for psychiatric comorbidity, with a clear dose-response relationship between number of mental disorders and subsequent pain. Early-onset disorders were stronger predictors of pain; when adjusting for psychiatric comorbidity, this remained the case for depression/dysthymia. No gender differences were observed. In conclusion, individuals with mental disorder, beyond depression and anxiety, are at higher risk of developing subsequent back/neck pain, stressing the importance of early detection of mental disorders, and highlight the need of assessing back/neck pain in mental health clinical settings. PERSPECTIVE Previous mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition are positively associated with subsequent back/neck pain onset, with a clear dose-response relationship between number of mental disorders and subsequent pain. Earlier-onset mental disorders are stronger predictors of subsequent pain onset, compared with later-onset disorders.
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Affiliation(s)
- Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitória, Brazil; Post Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil.
| | - Carmen C W Lim
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Flavia Garcia Pereira
- Post Graduate Program in Public Health, Federal University of Espírito Santo, Vitória, Brazil
| | - Sergio Aguilar-Gaxiola
- University of California, Davis, Center for Reducing Health Disparities, School of Medicine, Sacramento, California
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum-Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium
| | - Peter de Jonge
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jose Miguel Caldas-de-Almeida
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Siobhan O'Neill
- Psychology Research Institute, University of Ulster, Londonderry, United Kingdom
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Graça Cardoso
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Giovanni de Girolamo
- IRCCS St. John of God Clinical Research Centre/IRCCS, Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Insitute of Mental Health & Shenzhen Kanging Hospital, Shenzen, China
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France
| | | | | | | | - Daniel Rabczenko
- Centre of Monitoring and Analyses of Population Health Status, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusettes
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
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McGrath JJ, Saha S, Lim CCW, Aguilar-Gaxiola S, Alonso J, Andrade LH, Bromet EJ, Bruffaerts R, Caldas de Almeida JM, Cardoso G, de Girolamo G, Fayyad J, Florescu S, Gureje O, Haro JM, Kawakami N, Koenen KC, Kovess-Masfety V, Lee S, Lepine JP, McLaughlin KA, Medina-Mora ME, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Sampson N, Scott KM, Tachimori H, ten Have M, Kendler KS, Kessler RC. Trauma and psychotic experiences: transnational data from the World Mental Health Survey. Br J Psychiatry 2017; 211:373-380. [PMID: 29097400 PMCID: PMC5709675 DOI: 10.1192/bjp.bp.117.205955] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/21/2017] [Accepted: 07/26/2017] [Indexed: 11/23/2022]
Abstract
BackgroundTraumatic events are associated with increased risk of psychotic experiences, but it is unclear whether this association is explained by mental disorders prior to psychotic experience onset.AimsTo investigate the associations between traumatic events and subsequent psychotic experience onset after adjusting for post-traumatic stress disorder and other mental disorders.MethodWe assessed 29 traumatic event types and psychotic experiences from the World Mental Health surveys and examined the associations of traumatic events with subsequent psychotic experience onset with and without adjustments for mental disorders.ResultsRespondents with any traumatic events had three times the odds of other respondents of subsequently developing psychotic experiences (OR = 3.1, 95% CI 2.7-3.7), with variability in strength of association across traumatic event types. These associations persisted after adjustment for mental disorders.ConclusionsExposure to traumatic events predicts subsequent onset of psychotic experiences even after adjusting for comorbid mental disorders.
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Affiliation(s)
- John J. McGrath
- Correspondence: John McGrath, Queensland Brain Institute, The University of Queensland, St Lucia, Queensland 4076, Australia.
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Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, Green JG, Hwang I, Kessler RC, Liu H, Mortier P, Nock MK, Pinder-Amaker S, Sampson NA, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Benjet C, Caldas-de-Almeida JM, Demyttenaere K, Florescu S, de Girolamo G, Gureje O, Haro JM, Karam EG, Kiejna A, Kovess-Masfety V, Lee S, McGrath JJ, O'Neill S, Pennell BE, Scott K, Ten Have M, Torres Y, Zaslavsky AM, Zarkov Z, Bruffaerts R. Mental disorders among college students in the World Health Organization World Mental Health Surveys - CORRIGENDUM. Psychol Med 2017; 47:2737. [PMID: 28462760 DOI: 10.1017/s0033291717001039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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McLaughlin KA, Koenen KC, Bromet EJ, Karam EG, Liu H, Petukhova M, Ruscio AM, Sampson NA, Stein DJ, Aguilar-Gaxiola S, Alonso J, Borges G, Demyttenaere K, Dinolova RV, Ferry F, Florescu S, de Girolamo G, Gureje O, Kawakami N, Lee S, Navarro-Mateu F, Piazza M, Pennell BE, Posada-Villa J, ten Have M, Viana MC, Kessler RC. Childhood adversities and post-traumatic stress disorder: evidence for stress sensitisation in the World Mental Health Surveys. Br J Psychiatry 2017; 211:280-288. [PMID: 28935660 PMCID: PMC5663970 DOI: 10.1192/bjp.bp.116.197640] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 11/23/2022]
Abstract
BackgroundAlthough childhood adversities are known to predict increased risk of post-traumatic stress disorder (PTSD) after traumatic experiences, it is unclear whether this association varies by childhood adversity or traumatic experience types or by age.AimsTo examine variation in associations of childhood adversities with PTSD according to childhood adversity types, traumatic experience types and life-course stage.MethodEpidemiological data were analysed from the World Mental Health Surveys (n = 27 017).ResultsFour childhood adversities (physical and sexual abuse, neglect, parent psychopathology) were associated with similarly increased odds of PTSD following traumatic experiences (odds ratio (OR) = 1.8), whereas the other eight childhood adversities assessed did not predict PTSD. Childhood adversity-PTSD associations did not vary across traumatic experience types, but were stronger in childhood-adolescence and early-middle adulthood than later adulthood.ConclusionsChildhood adversities are differentially associated with PTSD, with the strongest associations in childhood-adolescence and early-middle adulthood. Consistency of associations across traumatic experience types suggests that childhood adversities are associated with generalised vulnerability to PTSD following traumatic experiences.
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Affiliation(s)
- Katie A. McLaughlin
- Correspondence: Katie A. McLaughlin, Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195, USA.
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38
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Bromet EJ, Nock MK, Saha S, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Borges G, Bruffaerts R, Degenhardt L, de Girolamo G, de Jonge P, Florescu S, Gureje O, Haro JM, He Y, Hu C, Karam EG, Kovess-Masfety V, Lee S, Lepine JP, Mneimneh Z, Navarro-Mateu F, Ojagbemi A, Posada-Villa J, Sampson NA, Scott KM, Stagnaro JC, Viana MC, Xavier M, Kessler RC, McGrath JJ. Association Between Psychotic Experiences and Subsequent Suicidal Thoughts and Behaviors: A Cross-National Analysis From the World Health Organization World Mental Health Surveys. JAMA Psychiatry 2017; 74:1136-1144. [PMID: 28854302 PMCID: PMC5710219 DOI: 10.1001/jamapsychiatry.2017.2647] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Community-based studies have linked psychotic experiences (PEs) with increased risks of suicidal thoughts and behaviors (STBs). However, it is not known if these associations vary across the life course or if mental disorders contribute to these associations. OBJECTIVE To examine the temporal association between PEs and subsequent STBs across the life span as well as the influence of mental disorders (antecedent to the STBs) on these associations. DESIGN, SETTING, AND PARTICIPANTS A total of 33 370 adult respondents across 19 countries from the World Health Organization World Mental Health Surveys were assessed for PEs, STBs (ie, ideation, plans, and attempts), and 21 DSM-IV mental disorders. Discrete-time survival analysis was used to investigate the associations of PEs with subsequent onset of STBs. MAIN OUTCOMES AND MEASURES Prevalence and frequency of STBs with PEs, and odds ratios and 95% CIs. RESULTS Of 33 370 included participants, among those with PEs (n = 2488), the lifetime prevalence (SE) of suicidal ideation, plans, and attempts was 28.5% (1.3), 10.8% (0.7), and 10.2% (0.7), respectively. Respondents with 1 or more PEs had 2-fold increased odds of subsequent STBs after adjusting for antecedent or intervening mental disorders (suicidal ideation: odds ratio, 2.2; 95% CI, 1.8-2.6; suicide plans: odds ratio, 2.1; 95% CI, 1.7-2.6; and suicide attempts: odds ratio, 1.9; 95% CI, 1.5-2.5). There were significant dose-response relationships of number of PE types with subsequent STBs that persisted after adjustment for mental disorders. Although PEs were significant predictors of subsequent STB onset across all life stages, associations were strongest in individuals 12 years and younger. After adjustment for antecedent mental disorders, the overall population attributable risk proportions for lifetime suicidal ideation, plans, and attempts associated with temporally prior PEs were 5.3%, 5.7%, and 4.8%, respectively. CONCLUSIONS AND RELEVANCE Psychotic experiences are associated with elevated odds of subsequent STBs across the life course that cannot be explained by antecedent mental disorders. These results highlight the importance of including information about PEs in screening instruments designed to predict STBs.
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Affiliation(s)
- Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
| | - Matthew K. Nock
- Psychology Department, Harvard University, Cambridge, Massachusetts
| | - Sukanta Saha
- Queensland Centre for Mental Health Research, Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Carmen C. W. Lim
- Queensland Centre for Mental Health Research, Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, University of California-Davis Health System, Sacramento
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya Governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain,Pompeu Fabra University, Barcelona, Spain,Centros de Investigación Biomédica en Red en Epidemiología y Salud Pública, Barcelona, Spain
| | - Guilherme Borges
- National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum, Katholieke Universiteit Leuven, Campus Gasthuisberg, Leuven, Belgium
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico–St John of God Clinical Research Centre, Brescia, Italy
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, the Netherlands,Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
| | - Silvia Florescu
- National School of Public Health, Management, and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red en Salud Mental, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Yanling He
- Shanghai Mental Health Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chiyi Hu
- Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon,Institute for Development, Research, Advocacy, and Applied Care, Beirut, Lebanon
| | | | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière-Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes-Paris Diderot, INSERM UMR-S 1144, Paris, France
| | - Zeina Mneimneh
- Survey Research Center, University of Michigan, Ann Arbor
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Menta, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria–Arrixaca, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública–Murcia, Murcia, Spain
| | - Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Juan C. Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Maria C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - Miguel Xavier
- Chronic Diseases Research Center, Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisbon, Portugal
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - John J. McGrath
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, Queensland, Australia,Queensland Brain Institute, University of Queensland, Brisbane, Queensland, Australia,National Centre for Register-Based Research, Aarhus School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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39
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Koenen KC, Ratanatharathorn A, Ng L, McLaughlin KA, Bromet EJ, Stein DJ, Karam EG, Ruscio AM, Benjet C, Scott K, Atwoli L, Petukhova M, Lim CC, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bunting B, Ciutan M, de Girolamo G, Degenhardt L, Gureje O, Haro JM, Huang Y, Kawakami N, Lee S, Navarro-Mateu F, Pennell BE, Piazza M, Sampson N, ten Have M, Torres Y, Viana MC, Williams D, Xavier M, Kessler RC. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol Med 2017; 47:2260-2274. [PMID: 28385165 PMCID: PMC6034513 DOI: 10.1017/s0033291717000708] [Citation(s) in RCA: 537] [Impact Index Per Article: 76.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. METHODS Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. RESULTS The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. CONCLUSIONS PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.
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Affiliation(s)
- K. C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - A. Ratanatharathorn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA
| | - L. Ng
- Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA
| | - K. A. McLaughlin
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - E. J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - D. J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - A. Meron Ruscio
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - C. Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - K. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - L. Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
| | - M. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - C. C.W. Lim
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
- Queensland Brain Institute, University of Queensland, St Lucia
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - S. Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - A. Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq
| | - J. Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Pompeu Fabra University (UPF); CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - B. Bunting
- School of Psychology, Ulster University, Londonderry, UK
| | - M. Ciutan
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - G. de Girolamo
- IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - L. Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - O. Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Y. Huang
- Institute of Mental Health, Peking University, Beijing, China
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - F. Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud IMIB-Arrixaca; CIBERESP-Murcia, Murcia, Spain
| | - B.-E. Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - M. Piazza
- Universidad Cayetano Heredia, Lima, Peru
- National Institute of Health, Lima, Peru
| | - N. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - M. ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Y. Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - M. C. Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - D. Williams
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massaschusetts, USA
| | - M. Xavier
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Stein DJ, Lim CCW, Roest AM, de Jonge P, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Benjet C, Bromet EJ, Bruffaerts R, de Girolamo G, Florescu S, Gureje O, Haro JM, Harris MG, He Y, Hinkov H, Horiguchi I, Hu C, Karam A, Karam EG, Lee S, Lepine JP, Navarro-Mateu F, Pennell BE, Piazza M, Posada-Villa J, Ten Have M, Torres Y, Viana MC, Wojtyniak B, Xavier M, Kessler RC, Scott KM. The cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative. BMC Med 2017; 15:143. [PMID: 28756776 PMCID: PMC5535284 DOI: 10.1186/s12916-017-0889-2] [Citation(s) in RCA: 192] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 06/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis. METHODS Data from 28 community surveys in the WMH Survey Initiative, with 142,405 respondents, were analyzed. We assessed the 30-day, 12-month, and lifetime prevalence of SAD, age of onset, and severity of role impairment associated with SAD, across countries. In addition, we investigated socio-demographic correlates of SAD, comorbidity of SAD with other mental disorders, and treatment of SAD in the combined sample. Cross-tabulations were used to calculate prevalence, impairment, comorbidity, and treatment. Survival analysis was used to estimate age of onset, and logistic regression and survival analyses were used to examine socio-demographic correlates. RESULTS SAD 30-day, 12-month, and lifetime prevalence estimates are 1.3, 2.4, and 4.0% across all countries. SAD prevalence rates are lowest in low/lower-middle income countries and in the African and Eastern Mediterranean regions, and highest in high income countries and in the Americas and the Western Pacific regions. Age of onset is early across the globe, and persistence is highest in upper-middle income countries, Africa, and the Eastern Mediterranean. There are some differences in domains of severe role impairment by country income level and geographic region, but there are no significant differences across different income level and geographic region in the proportion of respondents with any severe role impairment. Also, across countries SAD is associated with specific socio-demographic features (younger age, female gender, unmarried status, lower education, and lower income) and with similar patterns of comorbidity. Treatment rates for those with any impairment are lowest in low/lower-middle income countries and highest in high income countries. CONCLUSIONS While differences in SAD prevalence across countries are apparent, we found a number of consistent patterns across the globe, including early age of onset, persistence, impairment in multiple domains, as well as characteristic socio-demographic correlates and associated psychiatric comorbidities. In addition, while there are some differences in the patterns of impairment associated with SAD across the globe, key similarities suggest that the threshold for diagnosis is similar regardless of country income levels or geographic location. Taken together, these cross-national data emphasize the international clinical and public health significance of SAD.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa.
| | - Carmen C W Lim
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand.,Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
| | - Annelieke M Roest
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, Groningen, Netherlands
| | - Peter de Jonge
- Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, Groningen, Netherlands.,Department of Developmental Psychology, University of Groningen, Groningen, Netherlands
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Pompeu Fabra University (UPF), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Giovanni de Girolamo
- IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Meredith G Harris
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia.,School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Yanling He
- Shanghai Mental Health Center, Shanghai, China
| | - Hristo Hinkov
- National Center for Public Health and Analyses, Sofia, Bulgaria
| | - Itsuko Horiguchi
- Center for Public Relations Strategy, Nagasaki University (Tokyo Office), Tokyo, Japan
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Aimee Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - Elie G Karam
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon.,Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon.,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Diderot and Paris Descartes, Paris, France
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Beth-Ellen Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Marina Piazza
- Universidad Cayetano Heredia, Lima, Peru.,National Institute of Health, Lima, Peru
| | | | - Margreet Ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - Bogdan Wojtyniak
- Centre of Monitoring and Analyses of Population Health, National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - Miguel Xavier
- Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Campo dos Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
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Navarro-Mateu F, Alonso J, Lim CCW, Saha S, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LH, Bromet EJ, Bruffaerts R, Chatterji S, Degenhardt L, de Girolamo G, de Jonge P, Fayyad J, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kovess-Masfety V, Lee S, Medina-Mora ME, Ojagbemi A, Pennell BE, Posada-Villa J, Scott KM, Stagnaro JC, Kendler KS, Kessler RC, McGrath JJ, Kessler RC, McGrath JJ. The association between psychotic experiences and disability: results from the WHO World Mental Health Surveys. Acta Psychiatr Scand 2017; 136:74-84. [PMID: 28542726 PMCID: PMC5664954 DOI: 10.1111/acps.12749] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE While psychotic experiences (PEs) are known to be associated with a range of mental and general medical disorders, little is known about the association between PEs and measures of disability. We aimed to investigate this question using the World Mental Health surveys. METHOD Lifetime occurrences of six types of PEs were assessed along with 21 mental disorders and 14 general medical conditions. Disability was assessed with a modified version of the WHO Disability Assessment Schedule. Descriptive statistics and logistic regression models were used to investigate the association between PEs and high disability scores (top quartile) with various adjustments. RESULTS Respondents with PEs were more likely to have top quartile scores on global disability than respondents without PEs (19.1% vs. 7.5%; χ2 = 190.1, P < 0.001) as well as greater likelihood of cognitive, social, and role impairment. Relationships persisted in each adjusted model. A significant dose-response relationship was also found for the PE type measures with most of these outcomes. CONCLUSIONS Psychotic experiences are associated with disability measures with a dose-response relationship. These results are consistent with the view that PEs are associated with disability regardless of the presence of comorbid mental or general medical disorders.
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Affiliation(s)
- Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud. IMIB-Arrixaca. CIBERESP-Murcia, Murcia, Spain
| | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Carmen C. W. Lim
- Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia
| | - Sukanta Saha
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
| | - Laura H. Andrade
- Section of Psychiatric Epidemiology - LIM 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Ronny Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
| | - Somnath Chatterji
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Via Pilastroni 4, Brescia, Italy
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, NL; Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical
| | - John Fayyad
- Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon; Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University,Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | | | - Akin Ojagbemi
- College of Medicine, University of Ibadan; University College Hospital, Ibadan, Nigeria
| | - Beth-Ellen Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Jose Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | | | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - John J. McGrath
- Queensland Centre for Mental Health Research, and Queensland Brain Institute, University of Queensland, St. Lucia, Queensland, Australia; and National Centre for Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - R. C. Kessler
- Department of Health Care Policy; Harvard Medical School; Boston MA USA
| | - J. J. McGrath
- Queensland Centre for Mental Health Research; University of Queensland; St. Lucia QLD Australia
- Queensland Brain Institute; University of Queensland; St. Lucia QLD Australia
- National Centre for Register-based Research; Aarhus BSS; Aarhus University; Aarhus Denmark
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42
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Ruscio AM, Hallion LS, Lim CCW, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade LH, Borges G, Bromet EJ, Bunting B, Caldas de Almeida JM, Demyttenaere K, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hinkov H, Hu C, de Jonge P, Karam EG, Lee S, Lepine JP, Levinson D, Mneimneh Z, Navarro-Mateu F, Posada-Villa J, Slade T, Stein DJ, Torres Y, Uda H, Wojtyniak B, Kessler RC, Chatterji S, Scott KM. Cross-sectional Comparison of the Epidemiology of DSM-5 Generalized Anxiety Disorder Across the Globe. JAMA Psychiatry 2017; 74:465-475. [PMID: 28297020 PMCID: PMC5594751 DOI: 10.1001/jamapsychiatry.2017.0056] [Citation(s) in RCA: 206] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
IMPORTANCE Generalized anxiety disorder (GAD) is poorly understood compared with other anxiety disorders, and debates persist about the seriousness of this disorder. Few data exist on GAD outside a small number of affluent, industrialized nations. No population-based data exist on GAD as it is currently defined in DSM-5. OBJECTIVE To provide the first epidemiologic data on DSM-5 GAD and explore cross-national differences in its prevalence, course, correlates, and impact. DESIGN, SETTING, AND PARTICIPANTS Data come from the World Health Organization World Mental Health Survey Initiative. Cross-sectional general population surveys were carried out in 26 countries using a consistent research protocol and assessment instrument. A total of 147 261 adults from representative household samples were interviewed face-to-face in the community. The surveys were conducted between 2001 and 2012. Data analysis was performed from July 22, 2015, to December 12, 2016. MAIN OUTCOMES AND MEASURES The Composite International Diagnostic Interview was used to assess GAD along with comorbid disorders, role impairment, and help seeking. RESULTS Respondents were 147 261 adults aged 18 to 99 years. The surveys had a weighted mean response rate of 69.5%. Across surveys, DSM-5 GAD had a combined lifetime prevalence (SE) of 3.7% (0.1%), 12-month prevalence of 1.8% (0.1%), and 30-day prevalence of 0.8% (0). Prevalence estimates varied widely across countries, with lifetime prevalence highest in high-income countries (5.0% [0.1%]), lower in middle-income countries (2.8% [0.1%]), and lowest in low-income countries (1.6% [0.1%]). Generalized anxiety disorder typically begins in adulthood and persists over time, although onset is later and clinical course is more persistent in lower-income countries. Lifetime comorbidity is high (81.9% [0.7%]), particularly with mood (63.0% [0.9%]) and other anxiety (51.7% [0.9%]) disorders. Severe role impairment is common across life domains (50.6% [1.2%]), particularly in high-income countries. Treatment is sought by approximately half of affected individuals (49.2% [1.2%]), especially those with severe role impairment (59.4% [1.8%]) or comorbid disorders (55.8% [1.4%]) and those living in high-income countries (59.0% [1.3%]). CONCLUSIONS AND RELEVANCE The findings of this study show that DSM-5 GAD is more prevalent than DSM-IV GAD and is associated with substantial role impairment. The disorder is especially common and impairing in high-income countries despite a negative association between GAD and socioeconomic status within countries. These results underscore the public health significance of GAD across the globe while uncovering cross-national differences in prevalence, course, and impairment that require further investigation.
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Affiliation(s)
| | - Lauren S. Hallion
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Carmen C. W. Lim
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, University of California Davis Health System, Sacramento
| | - Ali Al-Hamzawi
- College of Medicine, Al-Qadisiya University, Diwania Governorate, Iraq
| | - Jordi Alonso
- Health Services Research Unit, Institut Municipal d'Investigació Médica–Hospital del Mar Medical Research Institute, Barcelona, Spain7Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain 8CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura Helena Andrade
- Department/Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Guilherme Borges
- Calzada México Xochimilco No. 101 Delegación Tlalpan, Distrito Federal, Mexico
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
| | - Brendan Bunting
- School of Psychology, Ulster University, Londonderry, United Kingdom
| | - José Miguel Caldas de Almeida
- Chronic Diseases Research Center and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Giovanni de Girolamo
- Istituto Di Ricovero e Cura a Carattere Scientifico, St John of God Clinical Research Centre, Brescia, Italy
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red Salud Mental, Universitat de Barcelona, Barcelona, Spain
| | - Yanling He
- Shanghai Mental Health Center, Shanghai, China
| | - Hristo Hinkov
- National Center for Public Health and Analyses, Sofia, Bulgaria
| | - Chiyi Hu
- Shenzhen Institute of Mental Health & Shenzhen Kanging Hospital, Shenzhen, China
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, the Netherlands23Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon25Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon26Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, University Paris Diderot and Paris Descartes, Paris, France
| | - Daphna Levinson
- Ministry of Health Israel, Mental Health Services, Jerusalem, Israel
| | - Zeina Mneimneh
- Institute for Development Research Advocacy and Applied Care, Beirut, Lebanon30Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor
| | - Fernando Navarro-Mateu
- Unidad de Docencia, Investigación y Formación en Salud Mental, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria–Arrixaca, Centro de Investigación Biomédica en Red Epidemiología y Salud Pública–Murcia, Murcia, Spain
| | | | - Tim Slade
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
| | - Hidenori Uda
- Health, Social Welfare, and Environmental Department, Kagoshima Regional Promotion Bureau, Kagoshima Prefecture, Japan
| | - Bogdan Wojtyniak
- Centre of Monitoring and Analyses of Population Health, National Institute of Public Health–National Institute of Hygiene, Warsaw, Poland
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Somnath Chatterji
- Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
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43
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McGrath JJ, McLaughlin KA, Saha S, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Bruffaerts R, de Girolamo G, de Jonge P, Esan O, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Kovess-Masfety V, Lee S, Lepine JP, Lim CCW, Medina-Mora ME, Mneimneh Z, Pennell BE, Piazza M, Posada-Villa J, Sampson N, Viana MC, Xavier M, Bromet EJ, Kendler KS, Kessler RC. The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of 23 998 respondents from 17 countries. Psychol Med 2017; 47:1230-1245. [PMID: 28065209 PMCID: PMC5590103 DOI: 10.1017/s0033291716003263] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations. METHOD We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models. RESULTS Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9-2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6-20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF). CONCLUSIONS Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.
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Affiliation(s)
- J J McGrath
- Queensland Centre for Mental Health Research, andQueensland Brain Institute,University of Queensland,Australia
| | - K A McLaughlin
- Department of Psychology,University of Washington,Seattle,Washington,USA
| | - S Saha
- Queensland Centre for Mental Health Research, andQueensland Brain Institute,University of Queensland,Australia
| | - S Aguilar-Gaxiola
- Center for Reducing Health Disparities,UC Davis Health System,Sacramento,California,USA
| | - A Al-Hamzawi
- College of Medicine, Al-Qadisiya University,Diwaniya governorate,Iraq
| | - J Alonso
- Health Services Research Unit,IMIM-Hospital del Mar Medical Research Institute,Barcelona,Spain
| | - R Bruffaerts
- Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL),Campus Gasthuisberg,Leuven,Belgium
| | - G de Girolamo
- IRCCS St John of God Clinical Research Centre,IRCCS Centro S. Giovanni di Dio Fatebenefratelli,Brescia,Italy
| | - P de Jonge
- Department of Developmental Psychology,Research Program Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen,Groningen,The Netherlands
| | - O Esan
- Department of Psychiatry,University of Ibadan,Nigeria
| | - S Florescu
- National School of Public Health, Management and Professional Development,Bucharest,Romania
| | - O Gureje
- Department of Psychiatry,University College Hospital,Ibadan,Nigeria
| | - J M Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona,Barcelona,Spain
| | - C Hu
- Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital,Shenzhen,China
| | - E G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine,Balamand University,Beirut,Lebanon
| | - V Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University,Paris,France
| | - S Lee
- Department of Psychiatry,Chinese University of Hong Kong,Tai Po,Hong Kong
| | - J P Lepine
- Hôpital Lariboisière Fernand Widal,Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144,University Paris Diderot and Paris Descartes,Paris,France
| | - C C W Lim
- Queensland Brain Institute, The University of Queensland,St. Lucia, Queensland,Australia
| | - M E Medina-Mora
- National Institute of Psychiatry Ramón de la Fuente,Mexico City,Mexico
| | - Z Mneimneh
- Survey Research Center,Institute for Social Research,University of Michigan,Ann Arbor,Michigan,USA
| | - B E Pennell
- Survey Research Center,Institute for Social Research,University of Michigan,Ann Arbor,Michigan,USA
| | - M Piazza
- Universidad Cayetano Heredia,Lima,Peru
| | - J Posada-Villa
- Colegio Mayor de Cundinamarca University,Bogota,Colombia
| | - N Sampson
- Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA
| | - M C Viana
- Department of Social Medicine,Federal University of Espírito Santo,Vitoria,Brazil
| | - M Xavier
- Department of Mental Health,Faculdade de Ciências Médicas,Chronic Diseases Research Center (CEDOC) and Universidade Nova de Lisboa,Campo dos Mártires da Pátria,Lisbon,Portugal
| | - E J Bromet
- Department of Psychiatry,Stony Brook University School of Medicine,Stony Brook,New York,USA
| | - K S Kendler
- Department of Psychiatry,Virginia Commonwealth University,USA
| | - R C Kessler
- Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA
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Abstract
The United States, under new executive orders proposed by its 45th president, may quickly lose its greatness in serving Emma Lazarus' untimely portrait of immigrants and refugees as "the tired, poor and huddled masses yearning to breathe free." After years of progress in improving health care access to underserved populations, new executive orders threaten our nation's advancements in health equity. Within this perspective, we offer examples on how these actions may result in damaging impacts on patients, families, communities and the health care workforce. We add our voices to a myriad of national leaders who are advocating for the preservation of the Affordable Care Act (ACA) and the protection of immigrants, including Deferred Action for Childhood Arrivals (DACA).
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Affiliation(s)
- Efrain Talamantes
- Center for Reducing Health Disparities, Division of General Internal Medicine, University of California, Davis School of Medicine, Sacramento, California
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, Division of General Internal Medicine, University of California, Davis School of Medicine, Sacramento, California
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45
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Lewis-Fernández R, Aggarwal NK, Lam PC, Galfalvy H, Weiss MG, Kirmayer LJ, Paralikar V, Deshpande SN, Díaz E, Nicasio AV, Boiler M, Alarcón RD, Rohlof H, Groen S, van Dijk RCJ, Jadhav S, Sarmukaddam S, Ndetei D, Scalco MZ, Bassiri K, Aguilar-Gaxiola S, Ton H, Westermeyer J, Vega-Dienstmaier JM. Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: mixed-methods results from the DSM-5 international field trial. Br J Psychiatry 2017; 210:290-297. [PMID: 28104738 DOI: 10.1192/bjp.bp.116.193862] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 09/27/2016] [Accepted: 09/28/2016] [Indexed: 11/23/2022]
Abstract
BackgroundThere is a need for clinical tools to identify cultural issues in diagnostic assessment.AimsTo assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.MethodMixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored.ResultsMixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time.ConclusionsThe CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.
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Affiliation(s)
- Roberto Lewis-Fernández
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Neil Krishan Aggarwal
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Peter C Lam
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Hanga Galfalvy
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Mitchell G Weiss
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Laurence J Kirmayer
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Vasudeo Paralikar
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Smita N Deshpande
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Esperanza Díaz
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Andel V Nicasio
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Marit Boiler
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Renato D Alarcón
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Hans Rohlof
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Simon Groen
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Rob C J van Dijk
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Sushrut Jadhav
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Sanjeev Sarmukaddam
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - David Ndetei
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Monica Z Scalco
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Kavoos Bassiri
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Sergio Aguilar-Gaxiola
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Hendry Ton
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Joseph Westermeyer
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
| | - Johann M Vega-Dienstmaier
- Roberto Lewis-Fernández, MD, MTS, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence, Anxiety Disorders Clinic, and Hispanic Treatment Program, at the New York State Psychiatric Institute, New York, New York, USA; Neil Krishan Aggarwal, MD, MBA, MA, Department of Psychiatry, Columbia University and New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Peter C. Lam, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Hanga Galfalvy, PhD, Departments of Psychiatry and Biostatistics, Columbia University and Division of Biostatistics, New York State Psychiatric Institute, New York, New York, USA; Mitchell G. Weiss, MD, PhD, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel Switzerland; Laurence J. Kirmayer, MD, Division of Social & Transcultural Psychiatry, McGill University and Culture & Mental Health Research Unit, Institute of Community & Family Psychiatry, Jewish General Hospital, Montreal, Quebec, Canada; Vasudeo Paralikar, MBBS, MD, PhD, Psychiatry Unit, King Edward Memorial Hospital, Pune, India; Smita N. Deshpande, MD, DPM, Department of Psychiatry, Post-Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India; Esperanza Díaz, MD, Department of Psychiatry, Yale University, New Haven, Connecticut, USA; Andel V. Nicasio, MSEd, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Marit Boiler, MPH, New York State Center of Excellence for Cultural Competence at the New York State Psychiatric Institute, New York, New York, USA; Renato D. Alarcón, MD, MPH, Department of Psychiatry, Mayo Clinic College of Medicine, Rochester, Minnesota, USA and Universidad Peruana Cayetano Heredia, Lima, Peru; Hans Rohlof, MD, Centrum '45, Oegstgeest, the Netherlands; Simon Groen, MA, Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands and De Evenaar Centre for Transcultural Psychiatry, GGZ Drenthe Mental Health Care, Assen, The Netherlands; Rob C. J. van Dijk, MSc, Parnassia Psychiatric Institute, The Hague, The Netherlands; Sushrut Jadhav, MBBS, MD, MRCPsych, PhD, Division of Psychiatry, University College London, London, UK; Sanjeev Sarmukaddam, PhD, Department of Biostatistics, Maharashtra Institute of Mental Health, Sassoon Govt. Hospital Campus, Pune, India; David Ndetei, MBChB, DPM, MRCPsych, FRCPsych, MD, DSc, Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenya; Monica Z. Scalco, MD, PhD, Department of Psychiatry, University of Toronto and Toronto Western Hospital, Toronto, Ontario, Canada; Kavoos Bassiri, MS, LMFT, LPCC, CGP, Richmond Area Multi-Services Inc. and Department of Psychiatry, University of California, San Francisco, San Francisco, California, USA; Sergio Aguilar-Gaxiola, MD, PhD, Department of Internal Medicine and Center for Reducing Health Disparities, University of California, Davis, Sacramento, California, USA; Hendry Ton, MD, MS, Department of Psychiatry and Behavioral Sciences and Center for Reducing Health Disparities, University of California, Davis and Asian Pacific Community Counseling-Transcultural Wellness Center, Sacramento, California, USA; Joseph Westermeyer, MD, PhD, Department of Psychiatry, University of Minnesota and Minneapolis VA Medical Center, Minneapolis, Minnesota, USA; Johann M. Vega-Dienstmaier, MD, Department of Psychiatry, Universidad Peruana Cayetano Heredia and Hospital Nacional Cayetano Heredia, Lima, Peru
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Atwoli L, Stein DJ, King A, Petukhova M, Aguilar-Gaxiola S, Alonso J, Bromet EJ, de Girolamo G, Demyttenaere K, Florescu S, Haro JM, Karam EG, Kawakami N, Lee S, Lepine JP, Navarro-Mateu F, O’Neill S, Pennell BE, Piazza M, Posada-Villa J, Sampson NA, ten Have M, Zaslavsky AM, Kessler RC. Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys. Depress Anxiety 2017; 34:315-326. [PMID: 27921352 PMCID: PMC5661943 DOI: 10.1002/da.22579] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 09/27/2016] [Accepted: 09/30/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about posttraumatic stress disorder (PTSD) after this experience. The WHO World Mental Health (WMH) survey initiative provides a unique opportunity to address these issues. METHODS Data from 19 WMH surveys (n = 78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent sociodemographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk. RESULTS PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high-income and low-middle income countries. Significant multivariate predictors included the deceased being a spouse or child, the respondent being female and believing they could have done something to prevent the death, prior trauma exposure, and history of prior mental disorders. The final model was strongly predictive of PTSD, with the 5% of respondents having highest estimated risk including 30.6% of all cases of PTSD. Positive predictive value (i.e., the proportion of high-risk individuals who actually developed PTSD) among the 5% of respondents with highest predicted risk was 25.3%. CONCLUSIONS The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and suggests that screening assessments might be useful in identifying high-risk individuals for preventive interventions.
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Affiliation(s)
- Lukoye Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Andrew King
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
| | - Jordi Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar; Pompeu Fabra University (UPF); and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Giovanni de Girolamo
- IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Koen Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Silvia Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University; Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center; and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Descartes – Paris Diderot, France
| | - Fernando Navarro-Mateu
- IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Murcia, Spain
| | - Siobhan O’Neill
- School of Psychology, University of Ulster, Londonderry, United Kingdom
| | - Beth-Ellen Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Marina Piazza
- Universidad Peruana Cayetano Heredia; and National Institute of Health, Lima, Peru
| | | | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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47
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Liu H, Petukhova MV, Sampson NA, Aguilar-Gaxiola S, Alonso J, Andrade LH, Bromet EJ, de Girolamo G, Haro JM, Hinkov H, Kawakami N, Koenen KC, Kovess-Masfety V, Lee S, Medina-Mora ME, Navarro-Mateu F, O’Neill S, Piazza M, Posada-Villa J, Scott KM, Shahly V, Stein DJ, ten Have M, Torres Y, Gureje O, Zaslavsky AM, Kessler RC. Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys. JAMA Psychiatry 2017; 74:270-281. [PMID: 28055082 PMCID: PMC5441566 DOI: 10.1001/jamapsychiatry.2016.3783] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Previous research has documented significant variation in the prevalence of posttraumatic stress disorder (PTSD) depending on the type of traumatic experience (TE) and history of TE exposure, but the relatively small sample sizes in these studies resulted in a number of unresolved basic questions. OBJECTIVE To examine disaggregated associations of type of TE history with PTSD in a large cross-national community epidemiologic data set. DESIGN, SETTING, AND PARTICIPANTS The World Health Organization World Mental Health surveys assessed 29 TE types (lifetime exposure, age at first exposure) with DSM-IV PTSD that was associated with 1 randomly selected TE exposure (the random TE) for each respondent. Surveys were administered in 20 countries (n = 34 676 respondents) from 2001 to 2012. Data were analyzed from October 1, 2015, to September 1, 2016. MAIN OUTCOMES AND MEASURES Prevalence of PTSD assessed with the Composite International Diagnostic Interview. RESULTS Among the 34 676 respondents (55.4% [SE, 0.6%] men and 44.6% [SE, 0.6%] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3% of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0%. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95% CI, 2.0-3.8) and witnessing atrocities (4.2; 95% CI, 1.0-17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95% CI, 1.3-7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95% CI, 0.1-0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95% CI, 1.0-1.6), experience of physical violence (OR, 1.4; 95% CI, 1.2-1.7), rape (OR, 2.5; 95% CI, 1.7-3.8), and other sexual assault (OR, 1.6; 95% CI, 1.1-2.3). CONCLUSION AND RELEVANCE The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.
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Affiliation(s)
- Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts2Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, University of California, Davis, Health System, Sacramento
| | - Jordi Alonso
- Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University, Barcelona, Spain5Group 9/Program 06–Evaluation of Health Services of Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology–Laboratórios de Investigação Médica No. 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
| | - Giovanni de Girolamo
- Istituto di Ricovero e Cura a Carattere Scientifico, Fatebenefratelli, Brescia, Italy
| | - Josep Maria Haro
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental, Universitat de Barcelona, Barcelona, Spain
| | - Hristo Hinkov
- National Center for Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique, EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong, China
| | - Maria Elena Medina-Mora
- Dirección de Investigaciones Epidemiológicas y Psicosociales, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Fernando Navarro-Mateu
- Servicio Murciano de Investigación y Formación en Salud Mental, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria–Arrixaca, CIBERESP, Murcia, Spain
| | - Siobhan O’Neill
- School of Psychology, Ulster University, Londonderry, Northern Ireland
| | - Marina Piazza
- Facultad de Salud Pública y Administración, Universidad Cayetano Heredia, Lima, Peru18National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Victoria Shahly
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade L, Borges G, Bruffaerts R, Bunting B, de Almeida JMC, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hinkov H, Karam E, Kawakami N, Lee S, Navarro-Mateu F, Piazza M, Posada-Villa J, de Galvis YT, Kessler RC. Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry 2017; 210:119-124. [PMID: 27908899 PMCID: PMC5288082 DOI: 10.1192/bjp.bp.116.188078] [Citation(s) in RCA: 498] [Impact Index Per Article: 71.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is a leading cause of disability worldwide. AIMS To examine the: (a) 12-month prevalence of DSM-IV MDD; (b) proportion aware that they have a problem needing treatment and who want care; (c) proportion of the latter receiving treatment; and (d) proportion of such treatment meeting minimal standards. METHOD Representative community household surveys from 21 countries as part of the World Health Organization World Mental Health Surveys. RESULTS Of 51 547 respondents, 4.6% met 12-month criteria for DSM-IV MDD and of these 56.7% reported needing treatment. Among those who recognised their need for treatment, most (71.1%) made at least one visit to a service provider. Among those who received treatment, only 41.0% received treatment that met minimal standards. This resulted in only 16.5% of all individuals with 12-month MDD receiving minimally adequate treatment. CONCLUSIONS Only a minority of participants with MDD received minimally adequate treatment: 1 in 5 people in high-income and 1 in 27 in low-/lower-middle-income countries. Scaling up care for MDD requires fundamental transformations in community education and outreach, supply of treatment and quality of services.
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Affiliation(s)
- Graham Thornicroft
- Graham Thornicroft, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Somnath Chatterji, MD, Department of Information, Evidence and Research, World Health Organization, Geneva, Switzerland; Sara Evans-Lacko, PhD, Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Michael Gruber, MS, Nancy Sampson, BA, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA; Sergio Aguilar-Gaxiola, MD, PhD, Center for Reduction in Health Disparities, University of California Davis, Sacramento, California, USA; Ali Al-Hamzawi, MD, College of Medicine, Al-Qadisia University, Diwania governorate, Iraq; Jordi Alonso, MD, PhD, Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Pompeu Fabra University (UPF), Barcelona, Spain; and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; Laura Andrade, MD, PhD, Section of Psychiatric Epidemiology, LIM-23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil; Guilherme Borges, ScD, Instituto Nacional de Psiquiatria, Calzada Mexico Xochimilco No 101, Colonia San Lorenzo Huipulco, Mexico; Ronny Bruffaerts, PhD, Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium; Brendan Bunting, PhD, Ulster University, Londonderry, Northern Ireland, UK; Jose Miguel Caldas de Almeida, MD, PhD, CEDOC and Department of Mental Health, Nova Medical School/Faculdade Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal; Silvia Florescu, MD, PhD, National School of Public Health, Management and Professional Development, Bucharest, Romania; Giovanni de Girolamo, MD, IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy; Oye Gureje, MD, PhD, Department of Psychiatry, University College Hospital, Ibadan, Nigeria; Josep Maria Haro, MD, PhD, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Sant Boi de Llobregat (Barcelona), Spain; Yanling He, MD, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Hristo Hinkov, MD, National Center for Public Health and Analyses, Sofia, Bulgaria; Elie Karam, MD, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, and Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon; Norito Kawakami, MD, PhD, Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan; Sing Lee, PhD, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong; Fernando Navarro-Mateu, MD, PhD, IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar, Murcia, Spain; Marina Piazza, ScD, Universidad Peruana Cayetano Heredia, Instituto Nacional de Salud, Lima, Peru; Jose Posada-Villa, MD, Colegio Mayor de Cundinamarca University, Bogota, Colombia; Yolanda Torres de Galvis, MPH, 'CES University', Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia; Ronald C. Kessler, PhD, Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
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Bromet EJ, Atwoli L, Kawakami N, Navarro-Mateu F, Piotrowski P, King AJ, Aguilar-Gaxiola S, Alonso J, Bunting B, Demyttenaere K, Florescu S, de Girolamo G, Gluzman S, Haro JM, de Jonge P, Karam EG, Lee S, Kovess-Masfety V, Medina-Mora ME, Mneimneh Z, Pennell BE, Posada-Villa J, Salmerón D, Takeshima T, Kessler RC. Post-traumatic stress disorder associated with natural and human-made disasters in the World Mental Health Surveys. Psychol Med 2017; 47:227-241. [PMID: 27573281 PMCID: PMC5432967 DOI: 10.1017/s0033291716002026] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Research on post-traumatic stress disorder (PTSD) following natural and human-made disasters has been undertaken for more than three decades. Although PTSD prevalence estimates vary widely, most are in the 20-40% range in disaster-focused studies but considerably lower (3-5%) in the few general population epidemiological surveys that evaluated disaster-related PTSD as part of a broader clinical assessment. The World Mental Health (WMH) Surveys provide an opportunity to examine disaster-related PTSD in representative general population surveys across a much wider range of sites than in previous studies. METHOD Although disaster-related PTSD was evaluated in 18 WMH surveys, only six in high-income countries had enough respondents for a risk factor analysis. Predictors considered were socio-demographics, disaster characteristics, and pre-disaster vulnerability factors (childhood family adversities, prior traumatic experiences, and prior mental disorders). RESULTS Disaster-related PTSD prevalence was 0.0-3.8% among adult (ages 18+) WMH respondents and was significantly related to high education, serious injury or death of someone close, forced displacement from home, and pre-existing vulnerabilities (prior childhood family adversities, other traumas, and mental disorders). Of PTSD cases 44.5% were among the 5% of respondents classified by the model as having highest PTSD risk. CONCLUSION Disaster-related PTSD is uncommon in high-income WMH countries. Risk factors are consistent with prior research: severity of exposure, history of prior stress exposure, and pre-existing mental disorders. The high concentration of PTSD among respondents with high predicted risk in our model supports the focus of screening assessments that identify disaster survivors most in need of preventive interventions.
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Affiliation(s)
- E. J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - L. Atwoli
- Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
| | - N. Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - F. Navarro-Mateu
- Subdirección General de Salud Mental, Servicio Murciano de Salud, IMIB-Arrixaca, CIBER de Epidemiología y Salud Pública (CIBERESP), Murcia, Spain
| | - P. Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - A. J. King
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - J. Alonso
- IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - B. Bunting
- School of Psychology, University of Ulster, Londonderry, UK
| | - K. Demyttenaere
- Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
| | - S. Florescu
- National School of Public Health, Management and Professional Development, Bucharest, Romania
| | - G. de Girolamo
- IRCCS St. John of God Clinical Research Centre, Brescia, Italy
| | - S. Gluzman
- Ukrainian Psychiatric Association, Kiev, Ukraine
| | - J. M. Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
| | - P. de Jonge
- Department of Psychiatry, Interdisciplinary Center, Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E. G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - S. Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - V. Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France
| | - M. E. Medina-Mora
- Ramon de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
| | - Z. Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - B.-E. Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | | | - D. Salmerón
- Department of Epidemiology, Department of Health and Social Sciences, Murcia Regional Health Council, IMIB-Arrixaca, CIBER Epidemiología y Salud Pública (CIBERESP), Universidad de Murcia, Murcia, Spain
| | - T. Takeshima
- Department of Health and Welfare for the Disabled, Health and Welfare Bureau, Kawasaki City, Japan
| | - R. C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
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50
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Kessler RC, Aguilar-Gaxiola S, Alonso J, Benjet C, Bromet EJ, Cardoso G, Degenhardt L, de Girolamo G, Dinolova RV, Ferry F, Florescu S, Gureje O, Haro JM, Huang Y, Karam EG, Kawakami N, Lee S, Lepine JP, Levinson D, Navarro-Mateu F, Pennell BE, Piazza M, Posada-Villa J, Scott KM, Stein DJ, Ten Have M, Torres Y, Viana MC, Petukhova MV, Sampson NA, Zaslavsky AM, Koenen KC. Trauma and PTSD in the WHO World Mental Health Surveys. Eur J Psychotraumatol 2017; 8:1353383. [PMID: 29075426 PMCID: PMC5632781 DOI: 10.1080/20008198.2017.1353383] [Citation(s) in RCA: 609] [Impact Index Per Article: 87.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/16/2017] [Accepted: 07/06/2017] [Indexed: 02/05/2023] Open
Abstract
Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their 'worst.' Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the 'worst' lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk. Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.
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Affiliation(s)
- Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | | | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain.,Departament de Ciències Experimentals i de la Salut, Pompeu Fabra University, Barcelona, Spain.,CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Corina Benjet
- Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muniz, Mexico City, Mexico
| | - Evelyn J Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre, Brescia, Italy
| | - Rumyana V Dinolova
- Sector "Mental Health", National Center of Public Health and Analyses, Sofia, Bulgaria
| | - Finola Ferry
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Northern Ireland
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat, Barcelona, Spain
| | - Yueqin Huang
- Institute of Mental Health, Peking University, Beijing, People's Republic of China
| | - Elie G Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon.,Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon.,Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Jean-Pierre Lepine
- Psychiatrie non sectorisée, Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris, Paris, France.,INSERM UMR-S 1144, Universités Paris Descartes-Paris Diderot, Paris, France
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Fernando Navarro-Mateu
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | - Beth-Ellen Pennell
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Marina Piazza
- Departamento Académico de Salud Pública, Administración y Ciencias Sociales, Universidad Peruana Cayetano Heredia, Lima, Peru.,La Unidad de Análisis y Generación de Evidencias en Salud Pública - UNAGESP, National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogotá, Colombia
| | - Kate M Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Margreet Ten Have
- Department of Epidemiology, Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Maria Carmen Viana
- Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
| | - Maria V Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Nancy A Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Alan M Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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